Basic Information
| Provider Information | |||||||||
| NPI: | 1679849889 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKE MONROE EMERGENCY PHYSICIANS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13737 NOEL RD | ||||||||
| Address2: | STE 1600 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752401331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694012386 | ||||||||
| FaxNumber: | 2147122444 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 W SEMINOLE BLVD | ||||||||
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| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327716743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073214500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2012 | ||||||||
| LastUpdateDate: | 06/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | GATEWOOD | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4694012386 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.