Healthcare Provider Details

I. General information

NPI: 1760773576
Provider Name (Legal Business Name): LORA SHUO WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N CAMPBELL AVE
TUCSON AZ
85719-1454
US

IV. Provider business mailing address

3838 N CAMPBELL AVE
TUCSON AZ
85719-1454
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-2002
  • Fax:
Mailing address:
  • Phone: 520-694-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number67219
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: