Provider Demographics
NPI:1689865289
Name:WANG, FANG (DO)
Entity Type:Individual
Prefix:
First Name:FANG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4625 MEADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3397
Mailing Address - Country:US
Mailing Address - Phone:214-663-4029
Mailing Address - Fax:972-669-1313
Practice Address - Street 1:4625 MEADOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3397
Practice Address - Country:US
Practice Address - Phone:214-663-4029
Practice Address - Fax:972-669-1313
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL9540207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL9540OtherMEDICAL LICENSE