Provider Demographics
NPI:1265477574
Name:EMERALD COAST EAR, NOSE, THROAT & ALLERGIES, P.A.
Entity Type:Organization
Organization Name:EMERALD COAST EAR, NOSE, THROAT & ALLERGIES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SIEFKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-796-1368
Mailing Address - Street 1:1032 MAR WALT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6645
Mailing Address - Country:US
Mailing Address - Phone:850-796-1368
Mailing Address - Fax:850-796-2368
Practice Address - Street 1:1032 MAR WALT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6645
Practice Address - Country:US
Practice Address - Phone:850-796-1368
Practice Address - Fax:850-796-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93776302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB64067Medicare UPIN
FLK9343Medicare ID - Type Unspecified