Basic Information
| Provider Information | |||||||||
| NPI: | 1407844574 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMMONS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | VAN BUREN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 909 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402010909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025880330 | ||||||||
| FaxNumber: | 5025880326 | ||||||||
| Practice Location | |||||||||
| Address1: | 529 S JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025624363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | MD.205855 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RH0000X | MD 422827 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RH0000X | 50871 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 08003322 | 05 | MS | MEDICAID | 2319086 | 05 | LA | MEDICAID | 1008228280001 | 05 | PA | MEDICAID | 7100514360 | 05 | KY | MEDICAID | 300011546 | 05 | IN | MEDICAID |