Provider Demographics
NPI:1457342164
Name:EMERY, CEDRIC B (MD)
Entity Type:Individual
Prefix:DR
First Name:CEDRIC
Middle Name:B
Last Name:EMERY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2807 LOMA VISTA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1500
Mailing Address - Country:US
Mailing Address - Phone:805-653-1533
Mailing Address - Fax:805-653-1536
Practice Address - Street 1:2807 LOMA VISTA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1500
Practice Address - Country:US
Practice Address - Phone:805-653-1533
Practice Address - Fax:805-653-1536
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-06-07
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Provider Licenses
StateLicense IDTaxonomies
CAG13489208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG13489OtherSTATE LICENSE
CAA38996Medicare UPIN
CAWG13489DMedicare ID - Type Unspecified