Provider Demographics
NPI:1225042088
Name:PREHN, WALTER C (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:C
Last Name:PREHN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:181 ANDRIEUX STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6920
Mailing Address - Country:US
Mailing Address - Phone:707-495-7762
Mailing Address - Fax:707-938-7337
Practice Address - Street 1:181 ANDRIEUX STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6920
Practice Address - Country:US
Practice Address - Phone:707-495-7762
Practice Address - Fax:707-938-7337
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-09-25
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Provider Licenses
StateLicense IDTaxonomies
CAG254540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G254540Medicaid
CA00G254540Medicaid
CA00G254540Medicare ID - Type Unspecified