Provider Demographics
NPI:1952399057
Name:METWALLY, YASER ABDEL-ALIM (MD)
Entity Type:Individual
Prefix:MR
First Name:YASER
Middle Name:ABDEL-ALIM
Last Name:METWALLY
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 1:707 MURPHY ROAD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-622-8900
Mailing Address - Fax:541-622-8901
Practice Address - Street 1:707 MURPHY ROAD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-622-8900
Practice Address - Fax:541-622-8901
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23381207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229285Medicaid
110775Medicare ID - Type Unspecified
OR229285Medicaid