Provider Demographics
NPI:1053492389
Name:WANG, PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6501 E GREENWAY PKWY STE 103
Mailing Address - Street 2:PMB #158
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2070
Mailing Address - Country:US
Mailing Address - Phone:602-494-5015
Mailing Address - Fax:602-445-9369
Practice Address - Street 1:6501 E GREENWAY PKWY STE 103
Practice Address - Street 2:PMB #158
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2070
Practice Address - Country:US
Practice Address - Phone:602-494-5015
Practice Address - Fax:602-445-9369
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4414208100000X, 2081P2900X
CA20A10222208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI63995Medicare UPIN