Provider Demographics
NPI:1073839486
Name:WG MEDICAL PLLC
Entity Type:Organization
Organization Name:WG MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-884-8033
Mailing Address - Street 1:700 MICHIGAN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1536
Mailing Address - Country:US
Mailing Address - Phone:716-884-8033
Mailing Address - Fax:716-884-8036
Practice Address - Street 1:700 MICHIGAN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1536
Practice Address - Country:US
Practice Address - Phone:716-884-8033
Practice Address - Fax:716-884-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care