Provider Demographics
NPI:1346535820
Name:WALWYN, EMRON O (MD)
Entity Type:Individual
Prefix:
First Name:EMRON
Middle Name:O
Last Name:WALWYN
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 1:1200 BRICKELL AVE
Mailing Address - Street 2:STE 1950
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3298
Mailing Address - Country:US
Mailing Address - Phone:504-756-1795
Mailing Address - Fax:
Practice Address - Street 1:1200 BRICKELL AVE
Practice Address - Street 2:STE 1950
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3298
Practice Address - Country:US
Practice Address - Phone:504-756-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121523207RG0300X, 207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAINTERNMedicaid