Provider Demographics
NPI:1346210655
Name:EMMERSON, DAVID ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:EMMERSON
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 1:7158 E DESERT MOON LOOP
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-0918
Mailing Address - Country:US
Mailing Address - Phone:520-403-0300
Mailing Address - Fax:
Practice Address - Street 1:7158 E DESERT MOON LOOP
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-0918
Practice Address - Country:US
Practice Address - Phone:520-403-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ77002085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCBBMOtherGROUP MEDICARE ID
AZ1346210655OtherPHYSICIAN INDIVIDUAL NPI
AZ300024033OtherMEDICARE RAILROAD
AZ248478Medicaid
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN
AZ1346210655OtherPHYSICIAN INDIVIDUAL NPI
AZ300024033OtherMEDICARE RAILROAD
AZZ30WCBBM22Medicare PIN
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN