Provider Demographics
NPI:1124084371
Name:BILLINGSLEY, EMILY DALE (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:DALE
Last Name:BILLINGSLEY
Suffix:
Gender:F
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:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402
Mailing Address - Country:US
Mailing Address - Phone:850-747-4905
Mailing Address - Fax:850-747-4907
Practice Address - Street 1:527 N PALO ALTO AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3639
Practice Address - Country:US
Practice Address - Phone:850-747-4905
Practice Address - Fax:850-747-4907
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME955652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275462200Medicaid
53015OtherBCBS
FLAA083UMedicare PIN
FLAA083WMedicare PIN
FLAA083VMedicare PIN