Organization
GATEWAY IOM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSUE GABRIEL M.D. (MANAGING MEMBER)
(464) 627-1335
Entity
Organization
Contact information
Practice address
4579 LACLEDE AVE # 446, SAINT LOUIS, MO 63108-2103
(314) 627-1335
Mailing address
4579 LACLEDE AVE # 446, SAINT LOUIS, MO 63108-2103
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
Primary
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Enumeration date
05/06/2016
Last updated
11/14/2016
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