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NPI Code Detail

MEDICARE: DR. RUSSELL IAN EMERSON M.D.

MEDICARE:  DR. RUSSELL IAN EMERSON  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
1207Q00000XFamily Medicine Physician35636NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00217229OTHERNCRAILROAD MEDICARE

Other Identifiers

General Provider Information

NPI Number : 1649267956
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUSSELL IAN EMERSON M.D.
Provider Business Mailing Address
First Line : 700 N MAIN ST
Second Line :
City : STANLEY
State : NC
Zip : 28164-1438
Country : US
Telephone Number : 704-263-8945
Fax Number : 704-263-2591
Provider Business Practice Location Address
First Line : 700 N MAIN ST
Second Line :
City : STANLEY
State : NC
Zip : 28164-1438
Country : US
Telephone Number : 704-263-8945
Fax Number : 704-263-2591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2005
Last Update Date : 07/08/2011

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