Individual
DR. RONALD GATEWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1220 JEFFERSON ST, LAUREL, MS 39440-4355
(601) 428-0100
Mailing address
PO BOX 2427, LAUREL, MS 39442-2427
(601) 428-0100
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
11034
MS
2085R0202X
Diagnostic Radiology Physician
Primary
11034
MS
2085R0204X
Vascular & Interventional Radiology Physician
11034
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00011086
—
MS
01
—
1942214846
GROUP MEDICARE NPI
—
Enumeration date
08/01/2006
Last updated
03/02/2021
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