Provider Demographics
NPI:1982642211
Name:WANG, MIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:
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 1:3445 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1678
Mailing Address - Country:US
Mailing Address - Phone:512-579-4000
Mailing Address - Fax:512-439-2814
Practice Address - Street 1:3445 EXECUTIVE CENTER DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1678
Practice Address - Country:US
Practice Address - Phone:512-579-4000
Practice Address - Fax:512-439-2814
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9958207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159969801Medicaid
TXP00052312OtherRAILROAD MEDICARE
TX8H3183OtherBCBS
TXP00052312OtherRAILROAD MEDICARE
TX8H3183OtherBCBS