Provider Demographics
NPI:1164621447
Name:POLAND, EMILY A (DO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:POLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:904-398-7205
Mailing Address - Fax:
Practice Address - Street 1:14540 OLD SAINT AUGUSTINE RD STE 2207
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7419
Practice Address - Country:US
Practice Address - Phone:904-652-0800
Practice Address - Fax:904-652-0811
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14897207RG0100X
SC36496207RG0100X
OH34.009018208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024387100Medicaid
OH4237503Medicare PIN
OHH000510Medicare PIN