Provider Demographics
NPI:1528513140
Name:MALCOLM JOHN WEHRLE MD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MALCOLM JOHN WEHRLE MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHRLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-653-7186
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64523207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE78318Medicare UPIN