Provider Demographics
NPI:1578621777
Name:EMERY, WALTER C (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:C
Last Name:EMERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3617
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-3617
Mailing Address - Country:US
Mailing Address - Phone:619-460-5111
Mailing Address - Fax:619-460-7815
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91944-3617
Practice Address - Country:US
Practice Address - Phone:619-460-5111
Practice Address - Fax:619-460-7815
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA16000207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A160000Medicaid
A20354Medicare UPIN