Provider Demographics
NPI:1881806834
Name:WANG, MARK JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1635 E MYRTLE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5514
Mailing Address - Country:US
Mailing Address - Phone:602-944-2900
Mailing Address - Fax:602-944-0064
Practice Address - Street 1:1635 E MYRTLE AVE STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5514
Practice Address - Country:US
Practice Address - Phone:602-944-2900
Practice Address - Fax:602-944-0064
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA83999207X00000X
AZ45261207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery