Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 023639 | LA |
N | 111NI0900X | Internist | 023639 | LA |
N | 207R00000X | Internist | MD 14803 | HI |
N | 111NI0900X | Internist | MD 14803 | HI |
N | 208000000X | Pediatrician | 023639 | LA |
N | 208000000X | Pediatrician | MD14803 | HI |
N | 208000000X | Pediatrician | ME94076 | FL |
NPI | 1003841222 |
---|---|
Provider Name | Dr. Olga Dorjima Emgushov |
First Address | Rockledge, FL 32955-4306 |
Second Address | Melbourne, FL 32901-3224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 25/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020269400 | (05) | FL |
DK923X | MEDICARE (01) | FL |