Provider Demographics
NPI:1740447176
Name:WADEN E EMERY III M D P A
Entity type:Organization
Organization Name:WADEN E EMERY III M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WADEN
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:954-771-8300
Mailing Address - Street 1:5340 N FEDERAL HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7058
Mailing Address - Country:US
Mailing Address - Phone:954-771-8300
Mailing Address - Fax:954-771-4002
Practice Address - Street 1:5340 N FEDERAL HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7058
Practice Address - Country:US
Practice Address - Phone:954-771-8300
Practice Address - Fax:954-771-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME452152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049128400Medicaid
FL94597Medicare PIN
FL049128400Medicaid