Provider Demographics
NPI:1326465394
Name:EMERE FLORIDA, P.A.
Entity Type:Organization
Organization Name:EMERE FLORIDA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:PROVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-239-5034
Mailing Address - Street 1:801 N 500 W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6829
Mailing Address - Country:US
Mailing Address - Phone:801-617-2100
Mailing Address - Fax:
Practice Address - Street 1:9878 CLINT MOORE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1037
Practice Address - Country:US
Practice Address - Phone:561-405-9610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL673092081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty