Organization
WATERCANAL ER SVCS PARTNERSHIP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH H. GATEWOOD M.D. (PRESIDENT)
(469) 401-2386
Entity
Organization
Contact information
Practice address
60 MEMORIAL MEDICAL PKWY, PALM COAST, FL 32164-5980
(386) 586-2010
(386) 676-4248
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275953500
—
FL
01
—
72262
BLUE SHIELD
FL
Enumeration date
05/05/2006
Last updated
06/20/2014
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