Healthcare Provider Details

I. General information

NPI: 1407844574
Provider Name (Legal Business Name): ROBERT VAN BUREN EMMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 S JACKSON ST
LOUISVILLE KY
40202-3229
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-562-4363
  • Fax:
Mailing address:
  • Phone: 502-588-0330
  • Fax: 502-588-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD.205855
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD 422827
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number50871
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: