Provider Demographics
NPI:1992738926
Name:HEMBERG, ERIC JOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOHAN
Last Name:HEMBERG
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 1:101 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6253
Mailing Address - Country:US
Mailing Address - Phone:334-610-2222
Mailing Address - Fax:334-610-2226
Practice Address - Street 1:101 24TH ST
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6253
Practice Address - Country:US
Practice Address - Phone:334-610-2222
Practice Address - Fax:334-610-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008688207Q00000X
AL8688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051014417OtherBLUE CROSS BLUE SHIELD
AL000014417Medicaid
AL009941242Medicaid
AL000014417Medicare ID - Type Unspecified
AL051014417OtherBLUE CROSS BLUE SHIELD
ALC72343Medicare UPIN
AL000014417Medicaid