MEDICARE: EMERALD ISLE PULMONARY MEDICINE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	ME61983	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15134	OTHER	FL	BCBS OF FLORIDA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649373762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD ISLE PULMONARY MEDICINE INC

Provider Business Mailing Address
First Line	:	PO BOX 9560
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32417-9560
Country	:	US
Telephone Number	:	850-872-0502
Fax Number	:	850-872-0677

Provider Business Practice Location Address
First Line	:	221 E 23RD ST
Second Line	:	SUITE B
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7612
Country	:	US
Telephone Number	:	850-872-0502
Fax Number	:	850-872-0677

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIMOTHY G MORIARTY
Credential	:	M.D.
Telephone Number	:	850-872-0502

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	02/02/2010

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