Provider Demographics
NPI:1477013613
Name:EMARA, AHMAD (DO)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:EMARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11420 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2237
Mailing Address - Country:US
Mailing Address - Phone:813-971-3136
Mailing Address - Fax:813-910-3569
Practice Address - Street 1:11420 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2237
Practice Address - Country:US
Practice Address - Phone:813-971-3136
Practice Address - Fax:813-910-3569
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS18233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program