Provider Demographics
NPI:1215915681
Name:GATEWOOD, ROBERT P JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:GATEWOOD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:SUITE 108 - CREDENTIALING DEPT
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4836
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:425 ESSJAY RD
Practice Address - Street 2:BUFFALO MEDICAL GROUP, PC
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5782
Practice Address - Country:US
Practice Address - Phone:716-630-1146
Practice Address - Fax:716-817-1729
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY124062207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY660068Medicaid
NY00010060701OtherUNIVERA
000508569001OtherBLUE CROSS COMMUNITY BLUE
2100905OtherINDEPENDENT HEALTH
2100905OtherINDEPENDENT HEALTH
NY660068Medicaid