Healthcare Provider Details

I. General information

NPI: 1326465394
Provider Name (Legal Business Name): EMERE FLORIDA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9878 CLINT MOORE RD SUITE 206
BOCA RATON FL
33496-1037
US

IV. Provider business mailing address

801 N 500 W SUITE 100
BOUNTIFUL UT
84010-6829
US

V. Phone/Fax

Practice location:
  • Phone: 561-405-9610
  • Fax:
Mailing address:
  • Phone: 801-617-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number67309
License Number StateFL

VIII. Authorized Official

Name: JAMES E PROVO
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential: M.D.
Phone: 917-239-5034