Provider Demographics
NPI:1013229608
Name:EMERALD BAY SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:EMERALD BAY SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-522-5022
Mailing Address - Street 1:2195 JENKS AVE
Mailing Address - Street 2:STE C
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4682
Mailing Address - Country:US
Mailing Address - Phone:850-522-5022
Mailing Address - Fax:850-522-5026
Practice Address - Street 1:2195 JENKS AVE
Practice Address - Street 2:STE C
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4682
Practice Address - Country:US
Practice Address - Phone:850-522-5022
Practice Address - Fax:850-522-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDQ071AMedicare PIN