Provider Demographics
NPI:1932187788
Name:WANG, BRUCE S (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 OSLER DR
Mailing Address - Street 2:STE 260
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5409
Mailing Address - Country:US
Mailing Address - Phone:817-652-2900
Mailing Address - Fax:
Practice Address - Street 1:331 OSLER DR
Practice Address - Street 2:STE 260
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5409
Practice Address - Country:US
Practice Address - Phone:817-652-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1126207V00000X
SD15317207V00000X
TXJ0898207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035996002Medicaid
TX035996001Medicaid