Provider Demographics
NPI:1669462628
Name:GATEWOOD, JAMES C (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:GATEWOOD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 COUCH AVE
Mailing Address - Street 2:ST. JOE HOSPITAL OF KIRKWOOD/ANESTHESIA DEPARTMENT
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5536
Mailing Address - Country:US
Mailing Address - Phone:573-636-3483
Mailing Address - Fax:573-636-7716
Practice Address - Street 1:1445 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-2853
Practice Address - Country:US
Practice Address - Phone:573-636-3483
Practice Address - Fax:573-636-5315
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132540367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8152966027Medicaid
MO8152966027Medicaid