Healthcare Provider Details

I. General information

NPI: 1902990377
Provider Name (Legal Business Name): MICHAEL R EMERY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 JEFFERSON ST NE
ALBUQUERQUE NM
87109-2155
US

IV. Provider business mailing address

PO BOX 6880
SANTA FE NM
87502-6880
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-9454
  • Fax: 505-888-9644
Mailing address:
  • Phone: 505-216-0332
  • Fax: 505-982-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-112699
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: