Provider Demographics
NPI:1487683579
Name:YOURCHEK, WALTER STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:STANLEY
Last Name:YOURCHEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4553 QUAIL LAKES DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-951-1133
Mailing Address - Fax:209-951-4708
Practice Address - Street 1:4553 QUAIL LAKES DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-951-1133
Practice Address - Fax:209-951-4708
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11189207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G111890Medicare ID - Type Unspecified
A38265Medicare UPIN