Provider Demographics
NPI:1821030065
Name:WANG-GOR, MIRANDA O (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:O
Last Name:WANG-GOR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9235 KATY FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1507
Mailing Address - Country:US
Mailing Address - Phone:713-461-2915
Mailing Address - Fax:713-461-2915
Practice Address - Street 1:11619 SHADOW CREEK PKWY # 110
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7262
Practice Address - Country:US
Practice Address - Phone:713-461-2915
Practice Address - Fax:713-461-5307
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM3786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G7742Medicare PIN
TXI60076Medicare UPIN