Individual
WALTER ALLAN EDMISTON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 E CALIFORNIA BLVD, 3RD FLOOR, PASADENA, CA 91105-3944
(626) 793-1227
(626) 793-3794
Mailing address
55 E CALIFORNIA BLVD, 3RD FLOOR, PASADENA, CA 91105-3944
(626) 793-1227
(626) 793-3794
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G23064
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G23064
BLUE SHIELD
CA
01
—
P01575801
MCR RR
CA
Enumeration date
04/18/2006
Last updated
02/05/2016
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