Provider Demographics
NPI:1316968282
Name:WEHRLE, MALCOLM JOHN (MD)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:JOHN
Last Name:WEHRLE
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 1:1203 E VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5622
Mailing Address - Country:US
Mailing Address - Phone:714-997-2674
Mailing Address - Fax:206-426-5175
Practice Address - Street 1:1203 E VERMONT AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5622
Practice Address - Country:US
Practice Address - Phone:714-997-2674
Practice Address - Fax:206-426-5175
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64523207L00000X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G645230Medicaid
CA00G645230OtherBLUE SHIELD
00G645230OtherBLUE SHIELD
E78318Medicare UPIN