Provider Demographics
NPI:1942280102
Name:WANG, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HIGHWAY 6 S
Mailing Address - Street 2:#100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4300
Mailing Address - Country:US
Mailing Address - Phone:281-496-4948
Mailing Address - Fax:
Practice Address - Street 1:2150 HIGHWAY 6 S
Practice Address - Street 2:#100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4300
Practice Address - Country:US
Practice Address - Phone:281-496-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6707207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1595746-05Medicaid
TXP00239407OtherRAILROAD MEDICARE PROV #
TX8J9905OtherBC/BS PROVIDER NUMBER
TXH89121Medicare UPIN
TX8J9905OtherBC/BS PROVIDER NUMBER