Provider Demographics
NPI:1497140610
Name:WANG, ROGER R (DO)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:R
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:202 SW 25TH AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8459
Mailing Address - Country:US
Mailing Address - Phone:940-463-7233
Mailing Address - Fax:940-463-7236
Practice Address - Street 1:202 SW 25TH AVE STE 700
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-8459
Practice Address - Country:US
Practice Address - Phone:940-463-7233
Practice Address - Fax:940-463-7236
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXS5291208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine