Provider Demographics
NPI:1831154319
Name:EMERY, WADEN EVERETT III (MD)
Entity type:Individual
Prefix:
First Name:WADEN
Middle Name:EVERETT
Last Name:EMERY
Suffix:III
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 1:5340 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME452152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049128400Medicaid
D63279Medicare UPIN
94597Medicare ID - Type Unspecified