Healthcare Provider Details

I. General information

NPI: 1831154319
Provider Name (Legal Business Name): WADEN EVERETT EMERY III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 N FEDERAL HWY SUITE 205
LIGHTHOUSE POINT FL
33064-7058
US

IV. Provider business mailing address

5340 N FEDERAL HWY SUITE 205
LIGHTHOUSE POINT FL
33064-7058
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8300
  • Fax: 954-771-4002
Mailing address:
  • Phone: 954-771-8300
  • Fax: 954-771-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME45215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: