Healthcare Provider Details

I. General information

NPI: 1972063543
Provider Name (Legal Business Name): JEFFREY WANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

9225 N 3RD ST STE 300
PHOENIX AZ
85020-2466
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-8040
  • Fax: 719-776-8050
Mailing address:
  • Phone: 602-445-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number008913
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0075390
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number008913
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: