Provider Demographics
NPI:1003046541
Name:FAN WANG MD PHD OB GYN PLLC
Entity Type:Organization
Organization Name:FAN WANG MD PHD OB GYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:832-782-3777
Mailing Address - Street 1:6 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-3900
Mailing Address - Country:US
Mailing Address - Phone:713-884-8887
Mailing Address - Fax:713-884-8480
Practice Address - Street 1:6671 SOUTHWEST FWY STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2220
Practice Address - Country:US
Practice Address - Phone:713-884-8887
Practice Address - Fax:713-884-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2236207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177382201Medicaid
TX612305Medicare PIN
TXI50684Medicare UPIN