MEDICARE: EMERALD BAY SURGICAL ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1013229608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD BAY SURGICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	2195 JENKS AVE
Second Line	:	STE C
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4682
Country	:	US
Telephone Number	:	850-522-5022
Fax Number	:	850-522-5026

Provider Business Practice Location Address
First Line	:	2195 JENKS AVE
Second Line	:	STE C
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4682
Country	:	US
Telephone Number	:	850-522-5022
Fax Number	:	850-522-5026

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NORMAN A JONES
Credential	:	MD
Telephone Number	:	850-522-5022

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	01/08/2014

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