Provider Demographics
NPI:1336117993
Name:EMERSON, JAMES M JR (PAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:EMERSON
Suffix:JR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:MARC
Other - Last Name:ENERSON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1324 LAKELAND HILLS BLVD.
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1324 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4543
Practice Address - Country:US
Practice Address - Phone:863-687-1321
Practice Address - Fax:863-284-1730
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2610363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7677TMedicare PIN
P62430Medicare UPIN
FL291531600Medicaid