Provider Demographics
NPI:1851342828
Name:WANG, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2919 S ELLSWORTH RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2164
Mailing Address - Country:US
Mailing Address - Phone:480-967-6888
Mailing Address - Fax:480-967-6887
Practice Address - Street 1:2919 S ELLSWORTH RD
Practice Address - Street 2:SUITE 135
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2164
Practice Address - Country:US
Practice Address - Phone:480-967-6888
Practice Address - Fax:480-967-6887
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ296682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ752987075OtherGREAT WEST
AZ752987075OtherLIFE WISE HEALTH CARE
AZ1Z6331OtherHEALTH NET
AZ4229278-001OtherCIGNA
AZAZ0712630OtherBLUE CROSS & BLUE SHIELD
AZ7080374OtherAETNA
AZ752987075OtherHUMANA
AZA002OtherTRICARE
AZ358680100OtherWORK COMP
AZ642852Medicaid
AZ752987075OtherPACIFICARE
AZ752987075OtherUNITED HEALTH CARE
AZP00079658OtherRAILROAD MEDICARE
AZ752987075OtherLIFE WISE HEALTH CARE
AZ642852Medicaid