Provider Demographics
NPI:1982656930
Name:WANG, PETER TH (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:TH
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3001 E PRESIDENT GEORGE BUSH HWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3542
Mailing Address - Country:US
Mailing Address - Phone:972-437-5099
Mailing Address - Fax:972-671-8428
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:SUITE 347
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-615-8757
Practice Address - Fax:210-615-8789
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL06822086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047505503Medicaid
TX8G6078Medicare ID - Type Unspecified
TXG69016Medicare UPIN