Provider Demographics
NPI:1730145160
Name:WANG, LIANG (MD)
Entity Type:Individual
Prefix:
First Name:LIANG
Middle Name:
Last Name:WANG
Suffix:
Gender:F
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:PO BOX 150171
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-0171
Mailing Address - Country:US
Mailing Address - Phone:512-765-4226
Mailing Address - Fax:
Practice Address - Street 1:507 COUNTY ROAD 128
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-5810
Practice Address - Country:US
Practice Address - Phone:737-226-6700
Practice Address - Fax:737-226-6777
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173154901Medicaid
TXP00258272Medicare PIN
TX8D5840Medicare PIN
TXI30778Medicare UPIN