Provider Demographics
NPI:1740209790
Name:WANG, EMILY S (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:S
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 2748
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78299-2748
Mailing Address - Country:US
Mailing Address - Phone:512-341-1258
Mailing Address - Fax:512-323-5287
Practice Address - Street 1:2400 ROUND ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4004
Practice Address - Country:US
Practice Address - Phone:512-341-1258
Practice Address - Fax:512-323-5287
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00211323OtherRAILROAD MEDICARE
TX8R7684OtherBLUE CROSS BLUE SHIELD
TX8D0481Medicare ID - Type Unspecified
TX8R7684OtherBLUE CROSS BLUE SHIELD