MEDICARE: JIMMY DEAN EMERY M.D.

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	207Q00000X	Family Medicine Physician	47674	AZ
2	207Q00000X	Family Medicine Physician	G32707	CA

General Provider Information

NPI Number	:	1295884336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY DEAN EMERY M.D.

Provider Business Mailing Address
First Line	:	2475 E GLEN CANYON RD
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-6361
Country	:	US
Telephone Number	:	520-398-6861
Fax Number	:	520-398-6861

Provider Business Practice Location Address
First Line	:	2475 E GLEN CANYON RD
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-6361
Country	:	US
Telephone Number	:	520-398-6861
Fax Number	:	520-398-6861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	05/08/2013

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