Emerald Coast Mood & Memory PA

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME 94223 Issued in FL

Legal business name

EMERALD COAST MOOD & MEMORY PA

Practice address

922 Mar Walt Dr
Suite 100
Fort Walton Beach, FL 32547-6630

Phone

(850) 226-4785

NPI assigned

Aug 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James Louis Igleburger, MD

Title

President Owner

Phone

(850) 226-4785

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710097704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "922 MAR WALT DR",
            "address_2": "SUITE 100",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476630",
            "telephone_number": "850-226-4785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 MAR WALT DR",
            "address_2": "SUITE 100",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476630",
            "telephone_number": "850-226-4785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST MOOD & MEMORY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IGLEBURGER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "850-226-4785",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME 94223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.