Provider Demographics
NPI:1164479531
Name:EMERSON, JANE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ANNE
Last Name:EMERSON
Suffix:
Gender:F
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:315 W BUSINESS LOOP 70
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3248
Practice Address - Country:US
Practice Address - Phone:573-884-0033
Practice Address - Fax:573-884-0055
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110552208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205361116Medicaid
MO751785OtherHEALTHLINK
MO209009OtherBLUE CHOICE
MOP00430563Medicare PIN
MO209009OtherBLUE CHOICE
MO205361116Medicaid
MO957522846Medicare PIN