Provider Demographics
NPI:1235155607
Name:EMRY, GORDON L (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:L
Last Name:EMRY
Suffix:
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 1:1604 TROON ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3377
Mailing Address - Country:US
Mailing Address - Phone:402-347-1441
Mailing Address - Fax:402-347-1440
Practice Address - Street 1:2024 W PASEWALK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4629
Practice Address - Country:US
Practice Address - Phone:402-844-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE17175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$07Medicaid
NE010048650Medicaid
NE264920Medicare ID - Type Unspecified