Provider Demographics
NPI:1982642567
Name:YRUMA, EMMANUEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:M
Last Name:YRUMA
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:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-0646
Mailing Address - Country:US
Mailing Address - Phone:360-794-7497
Mailing Address - Fax:360-435-0509
Practice Address - Street 1:14701 179TH AVE SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1108
Practice Address - Country:US
Practice Address - Phone:360-794-7497
Practice Address - Fax:360-618-7662
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2160YROtherBSWA
WA8270373Medicaid
WA0202161OtherLIWA
WA8270373Medicaid
WAG8856015Medicare PIN
WA2160YROtherBSWA
WAF91680Medicare UPIN