MEDICARE: DR. FAN YANG MD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME92711	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427085117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAN YANG MD PHD

Provider Business Mailing Address
First Line	:	12701 COMMONWEALTH DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-8626
Country	:	US
Telephone Number	:	239-768-0600
Fax Number	:	239-768-1672

Provider Business Practice Location Address
First Line	:	12701 COMMONWEALTH DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-8626
Country	:	US
Telephone Number	:	239-768-0600
Fax Number	:	239-768-1672

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	05/12/2009

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