1851342828 NPI number — DR. GEORGE WANG M.D

Table of content: DR. GEORGE WANG M.D (NPI 1851342828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851342828 NPI number — DR. GEORGE WANG M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
GEORGE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851342828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2919 S ELLSWORTH RD
Provider Second Line Business Mailing Address:
SUITE 135
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85212-2164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-967-6888
Provider Business Mailing Address Fax Number:
480-967-6887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2919 S ELLSWORTH RD
Provider Second Line Business Practice Location Address:
SUITE 135
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85212-2164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-967-6888
Provider Business Practice Location Address Fax Number:
480-967-6887
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  29668 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 752987075 . This is a "GREAT WEST" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 752987075 . This is a "LIFE WISE HEALTH CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z6331 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 4229278-001 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0712630 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7080374 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 752987075 . This is a "HUMANA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: A002 . This is a "TRICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 358680100 . This is a "WORK COMP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 642852 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 752987075 . This is a "PACIFICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 752987075 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P00079658 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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