Provider Demographics
NPI:1982655403
Name:WANG, GEORGE Z (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:Z
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ZHONGSHAN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8311
Mailing Address - Fax:
Practice Address - Street 1:3377 RIVERBEND DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8803
Practice Address - Country:US
Practice Address - Phone:541-222-6389
Practice Address - Fax:541-222-6385
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0052439208M00000X, 207R00000X
ORMD178859208M00000X
LA332513207R00000X
OH35-08-1700-W207R00000X
IN01080593207R00000X
IDM-13428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2350745Medicaid
CO42978319Medicaid
ORMD178859OtherOREGON MEDICAL LICENSE
COP01208858OtherRAILROAD MEDICARE
CO42978319Medicaid
OH4094801Medicare PIN
OHH76307Medicare UPIN