Provider Demographics
NPI:1649373762
Name:EMERALD ISLE PULMONARY MEDICINE INC
Entity type:Organization
Organization Name:EMERALD ISLE PULMONARY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-872-0502
Mailing Address - Street 1:PO BOX 9560
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32417-9560
Mailing Address - Country:US
Mailing Address - Phone:850-872-0502
Mailing Address - Fax:850-872-0677
Practice Address - Street 1:221 E 23RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7612
Practice Address - Country:US
Practice Address - Phone:850-872-0502
Practice Address - Fax:850-872-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61983207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15134OtherBCBS OF FLORIDA
FL370919100Medicaid
FL370919100Medicaid