MEDICARE: DR. SHAWN CLARK 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	11379	NV
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A77415	CA

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
2	XPY068120	OTHER	NV	MEDICAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821090150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN CLARK EMERY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 576768
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95357-6768
Country	:	US
Telephone Number	:	209-723-4551
Fax Number	:	209-723-0141

Provider Business Practice Location Address
First Line	:	3172 COLLINS DR STE B
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-3131
Country	:	US
Telephone Number	:	209-723-4551
Fax Number	:	209-723-0141

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/21/2022

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Directions to “ DR. SHAWN CLARK EMERY M.D.” Practice Location

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