Provider Demographics
NPI:1427165042
Name:N. D. EMERSON, P.C.
Entity type:Organization
Organization Name:N. D. EMERSON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-319-8459
Mailing Address - Street 1:1405 4TH AVE NW
Mailing Address - Street 2:SUITE 328
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2708
Mailing Address - Country:US
Mailing Address - Phone:580-223-5919
Mailing Address - Fax:580-220-2810
Practice Address - Street 1:1011 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1828
Practice Address - Country:US
Practice Address - Phone:580-223-5919
Practice Address - Fax:580-220-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522193Medicare PIN
F34761Medicare UPIN