Individual
DR. OLGA DORJIMA EMGUSHOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD,MPH
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1771
(321) 434-1775
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1981
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
023639
LA
207R00000X
Internal Medicine Physician
MD 14803
HI
208000000X
Pediatrics Physician
023639
LA
208000000X
Pediatrics Physician
MD14803
HI
208000000X
Pediatrics Physician
ME94076
FL
208M00000X
Hospitalist Physician
Primary
ME94076
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020269400
—
FL
01
—
DK923X
MEDICARE
FL
Enumeration date
07/12/2006
Last updated
09/25/2017
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