Provider Demographics
NPI:1649443334
Name:WALTER E YURY, INC
Entity type:Organization
Organization Name:WALTER E YURY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:E
Authorized Official - Last Name:YURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-879-6009
Mailing Address - Street 1:1211 W LA PALMA AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2815
Mailing Address - Country:US
Mailing Address - Phone:714-879-6009
Mailing Address - Fax:714-879-6008
Practice Address - Street 1:1211 W LA PALMA AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2815
Practice Address - Country:US
Practice Address - Phone:714-879-6009
Practice Address - Fax:714-879-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC20769BOtherMEDICARE
CAA86668Medicare UPIN
CAW16565Medicare PIN