Provider Demographics
NPI:1316985849
Name:EMIG, ERIC WARD (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WARD
Last Name:EMIG
Suffix:
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:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0980
Mailing Address - Country:US
Mailing Address - Phone:662-620-7101
Mailing Address - Fax:662-842-1457
Practice Address - Street 1:620 CROSSOVER ROAD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4944
Practice Address - Country:US
Practice Address - Phone:662-620-7101
Practice Address - Fax:662-842-1457
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS147992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009700320Medicaid
MS300061754OtherRAILROAD MEDICARE
MS00116720Medicaid
MS300000404Medicare PIN
MS300061754OtherRAILROAD MEDICARE
MSG24740Medicare UPIN
MS300001096Medicare PIN