Individual
MYESA H EMBERESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 N. STATE OF FRANKLIN ROAD, ST. JUDE'S TRI-CITIES AFFILIATE, JOHNSON CITY, TN 37604
(423) 431-3950
(423) 431-3958
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 431-3950
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
MD61093
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306251269
—
NY
Enumeration date
06/29/2014
Last updated
07/31/2020
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