Healthcare Provider Details

I. General information

NPI: 1437118718
Provider Name (Legal Business Name): JOSEPH L WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 W STADIUM BLVD
JEFFERSON CITY MO
65109-6023
US

IV. Provider business mailing address

1241 W STADIUM BLVD
JEFFERSON CITY MO
65109-6023
US

V. Phone/Fax

Practice location:
  • Phone: 573-635-5264
  • Fax: 573-556-1719
Mailing address:
  • Phone: 573-635-5264
  • Fax: 573-556-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number105279
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-26081
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number105279
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: