Provider Demographics
NPI:1518959048
Name:EMERY, NATHAN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:RICHARD
Last Name:EMERY
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 1:6950 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1210
Mailing Address - Country:US
Mailing Address - Phone:727-343-3004
Mailing Address - Fax:727-345-0454
Practice Address - Street 1:6950 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1210
Practice Address - Country:US
Practice Address - Phone:727-343-3004
Practice Address - Fax:727-345-0454
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87263207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0130315OtherGHI
FLP00250605OtherRAILROAD MEDICARE
FL5451200001OtherCIGNA GOVERNMENT SERVICES
FL71424OtherBLUE CROSS/BLUE SHIELD
FL71424OtherBLUE CROSS/BLUE SHIELD
FLU0702ZMedicare ID - Type Unspecified