Organization · NPI-2
Country Road Emergency Physicians, PLLC
Emergency Medicine · Port Arthur, TX
NPI number1346614294
StatusActive
Last updated in NPPESDec 14, 2015
Details
- NPI
- 1346614294
- Entity type
- Organization (NPI-2)
- Legal business name
- Country Road Emergency Physicians, PLLC
- Organization subpart
- No
- Enumeration date
- Nov 16, 2015
- Last updated
- Dec 14, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207P00000X | Emergency Medicine | – | – | Yes |
| 363A00000X | Physician Assistant | – | – | |
| 363L00000X | Nurse Practitioner | – | – |
Practice location
3600 Gates BlvdPort Arthur, TX 77642-3858
Phone 469-401-2386
Mailing address
Po Box 98953Las Vegas, NV 89193-8692
Authorized official
Joseph H Gatewood, M.D.
Officer
4694012386
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