Provider Demographics
NPI:1407016579
Name:WANG, YUAN (MD)
Entity Type:Individual
Prefix:
First Name:YUAN
Middle Name:
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 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:HOSPITALIST DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6796
Mailing Address - Country:US
Mailing Address - Phone:850-863-8100
Mailing Address - Fax:850-862-2303
Practice Address - Street 1:1005 MAR WALT DRIVE
Practice Address - Street 2:HOSPITALIST DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6796
Practice Address - Country:US
Practice Address - Phone:850-863-8100
Practice Address - Fax:850-862-2303
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114559208M00000X, 208M00000X
MO2005012150208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008209400Medicaid
FL14P6NOtherBCBSFL
FL008209400Medicaid