Provider Demographics
NPI:1558357988
Name:WANG, JEFF C (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:C
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 1:1702 FM 1960 BYPASS RD E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3916
Mailing Address - Country:US
Mailing Address - Phone:281-446-7173
Mailing Address - Fax:281-446-3841
Practice Address - Street 1:1702 FM 1960 BYPASS RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3916
Practice Address - Country:US
Practice Address - Phone:281-446-7173
Practice Address - Fax:281-446-3841
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX04216401Medicaid
G95661Medicare UPIN
TX83652KMedicare ID - Type Unspecified