Organization
GATEWAY SURGICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICKEY PICKLER (VP)
(386) 755-6682
Entity
Organization
Contact information
Practice address
3140 NW MEDICAL CENTER LN, SUITE 120, LAKE CITY, FL 32055-4717
(386) 755-6682
(386) 755-6796
Mailing address
3140 NW MEDICAL CENTER LN, SUITE 120, LAKE CITY, FL 32055-4717
(386) 755-6682
(386) 755-6796
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94830
BCBS OF FL
FL
Enumeration date
06/12/2006
Last updated
01/14/2008
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