Provider Demographics
NPI:1932191590
Name:WANG, BENJAMIN Y (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:Y
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:PO BOX 2030
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-2030
Mailing Address - Country:US
Mailing Address - Phone:855-381-9178
Mailing Address - Fax:913-234-1116
Practice Address - Street 1:2001 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3320
Practice Address - Country:US
Practice Address - Phone:915-577-6011
Practice Address - Fax:915-577-7068
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK46042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM16427726Medicaid
TXP00995222OtherRR MEDICARE
TX044009102Medicaid
TX8C7335Medicare PIN
NM16427726Medicaid