=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710375670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERALD SHORES RHEUMATOLOGY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2014
-----------------------------------------------------
Last Update Date | 05/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1290 WHISPER BAY BLVD
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32563-2677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-684-3445
-----------------------------------------------------
Fax | 850-684-3446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1290 WHISPER BAY BLVD
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32563-2677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-684-3445
-----------------------------------------------------
Fax | 850-684-3446
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. RACHEL WILLIAMS BROWN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 850-684-3445
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | ME107420
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------