Provider Demographics
NPI:1255315495
Name:EMERICK, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:EMERICK
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 1:4423 POINT FOSDICK DR NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1797
Mailing Address - Country:US
Mailing Address - Phone:253-432-4466
Mailing Address - Fax:253-432-4468
Practice Address - Street 1:4423 POINT FOSDICK DR NW
Practice Address - Street 2:SUITE 300
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1797
Practice Address - Country:US
Practice Address - Phone:253-432-4466
Practice Address - Fax:253-432-4468
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040562207RC0000X
ORMD212735207RI0011X
KY49027207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8289738Medicaid
WAAB25748Medicare ID - Type Unspecified
WA8289738Medicaid
G41781Medicare UPIN