Provider Demographics
NPI:1114965928
Name:WANG, JEREMY CHENG-YUH (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:CHENG-YUH
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18333 EGRET BAY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3860
Mailing Address - Country:US
Mailing Address - Phone:281-333-1300
Mailing Address - Fax:281-333-1303
Practice Address - Street 1:18333 EGRET BAY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3860
Practice Address - Country:US
Practice Address - Phone:281-333-1300
Practice Address - Fax:281-333-1303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2187207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S5380OtherBCBS
TX8S5380OtherBCBS
TX8G1087Medicare ID - Type Unspecified