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Organization
SPARKLING SEA EMERGENCY PHYSICIANS PLLC
Active
Organization
SPARKLING SEA EMERGENCY PHYSICIANS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEPH H. GATEWOOD MD (PRESIDENT)
(469) 401-2386
Entity
Organization
Contact information
Practice address
2606 HOSPITAL BLVD, CORPUS CHRISTI, TX 78405-1804
(361) 902-4000
(214) 712-2444
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(469) 401-2386
(214) 712-2444
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062NZ
BLUE SHIELD
TX
05
—
186699801
—
TX
Enumeration date
10/06/2006
Last updated
06/04/2014
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