Provider Demographics
NPI:1003584475
Name:EMERALD ENT ALLERGY HEARING AND FACIAL PLASTICS LLC
Entity Type:Organization
Organization Name:EMERALD ENT ALLERGY HEARING AND FACIAL PLASTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:GEGG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-610-3313
Mailing Address - Street 1:141 MACK BAYOU LOOP STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7194
Mailing Address - Country:US
Mailing Address - Phone:850-797-6191
Mailing Address - Fax:850-797-6191
Practice Address - Street 1:141 MACK BAYOU LOOP STE 102
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7194
Practice Address - Country:US
Practice Address - Phone:850-797-6191
Practice Address - Fax:850-420-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty