MEDICARE: NOEL W. EMERSON D.O.

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	3521	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801896709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEL W. EMERSON D.O.

Provider Business Mailing Address
First Line	:	795 S BIG BEN RD
Second Line	:
City	:	ATOKA
State	:	OK
Zip	:	74525-4501
Country	:	US
Telephone Number	:	580-889-6399
Fax Number	:	580-889-6659

Provider Business Practice Location Address
First Line	:	1510 S VIRGINIA AVE
Second Line	:
City	:	ATOKA
State	:	OK
Zip	:	74525-3246
Country	:	US
Telephone Number	:	580-889-6621
Fax Number	:	580-889-3602

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/03/2020

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