Provider Demographics
NPI:1619730520
Name:ANTI-AGING AND WELLNESS MD PLLC
Entity Type:Organization
Organization Name:ANTI-AGING AND WELLNESS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-283-9458
Mailing Address - Street 1:419 COLE ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-5017
Mailing Address - Country:US
Mailing Address - Phone:281-973-0024
Mailing Address - Fax:281-973-0203
Practice Address - Street 1:11548 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2448
Practice Address - Country:US
Practice Address - Phone:281-973-0024
Practice Address - Fax:281-973-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty