Provider Demographics
NPI:1093710162
Name:EMMERT, GREGOR K JR (MD)
Entity Type:Individual
Prefix:
First Name:GREGOR
Middle Name:K
Last Name:EMMERT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 EXECUTIVE PKWY
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1319
Mailing Address - Country:US
Mailing Address - Phone:419-531-8558
Mailing Address - Fax:419-578-5939
Practice Address - Street 1:3500 EXECUTIVE PKWY
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1319
Practice Address - Country:US
Practice Address - Phone:419-531-8558
Practice Address - Fax:419-578-5939
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3566454208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH340008355OtherRAILROAD MEDICARE
OH0977948Medicaid
OHEM0760081Medicare PIN
OH0977948Medicaid
F63335Medicare UPIN