Provider Demographics
NPI:1407860786
Name:EMMERTON, ERNEST EDWIN III (DO)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:EDWIN
Last Name:EMMERTON
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:600 N MAIN ST
Mailing Address - Street 2:VA OUTPATIENT CLINIC
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1004
Mailing Address - Country:US
Mailing Address - Phone:417-466-0108
Mailing Address - Fax:417-466-0199
Practice Address - Street 1:600 N MAIN ST
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1004
Practice Address - Country:US
Practice Address - Phone:417-466-0108
Practice Address - Fax:417-466-0199
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7G69207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine