Provider Demographics
NPI:1932109642
Name:EMDUR, LARRY I (DO, PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:I
Last Name:EMDUR
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:STE 2309
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5241
Mailing Address - Country:US
Mailing Address - Phone:619-698-3004
Mailing Address - Fax:619-698-9480
Practice Address - Street 1:6719 ALVARADO RD
Practice Address - Street 2:#108
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5270
Practice Address - Country:US
Practice Address - Phone:619-286-8803
Practice Address - Fax:619-286-2344
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4940207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ39696ZOtherBLUE CROSS
CA00AX4940OtherMEDI-CAL
CA20A4940OtherLICENSE
CA00AX4940OtherMEDI-CAL
CAZZZ39696ZOtherBLUE CROSS