MEDICARE: WADEN EVERETT EMERY III MD

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	2084N0400X	Neurology Physician	ME45215	FL

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	:	1831154319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WADEN EVERETT EMERY III MD

Provider Business Mailing Address
First Line	:	5340 N FEDERAL HWY
Second Line	:	SUITE 205
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7058
Country	:	US
Telephone Number	:	954-771-8300
Fax Number	:	954-771-4002

Provider Business Practice Location Address
First Line	:	5340 N FEDERAL HWY
Second Line	:	SUITE 205
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7058
Country	:	US
Telephone Number	:	954-771-8300
Fax Number	:	954-771-4002

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	12/10/2009

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