Provider Demographics
NPI:1689924060
Name:WANG, JOHN Q (PAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:Q
Last Name:WANG
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
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Mailing Address - Street 1:130 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4942
Mailing Address - Country:US
Mailing Address - Phone:936-827-4069
Mailing Address - Fax:
Practice Address - Street 1:130 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 7
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4942
Practice Address - Country:US
Practice Address - Phone:936-827-4069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant