# DAMON GATEWOOD MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kentucky River Medical Partners
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962574897
- **Authorized official:** DR. DAMON L GATEWOOD MD (OWNER)
- **Authorized official phone:** (502) 532-7341

## Contact information

- **Practice address:** 58 CITATION LANE, CAMPBELLSBURG, KY 40011-1426
- **Practice address phone:** (502) 532-7341
- **Practice address fax:** (502) 532-0127
- **Mailing address:** 58 CITATION LANE, CAMPBELLSBURG, KY 40011-1426
- **Mailing address phone:** (502) 532-7341
- **Mailing address fax:** (502) 532-0127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 37028 | KY | Yes |
| 363LF0000X | Family Nurse Practitioner | 3007904 | KY | — |

## Other

- **Enumeration date:** 11/15/2006
- **Last updated:** 06/05/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 50003253 | PASSPORT HEALTH PLAN | KY |
| 05 | — | 7100268000 | — | KY |
| 05 | — | 7100282440 | — | KY |