Healthcare Provider Details

I. General information

NPI: 1780117754
Provider Name (Legal Business Name): TRACY WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N GRAND AVE
GAINESVILLE TX
76240-3573
US

IV. Provider business mailing address

801 N GRAND AVE
GAINESVILLE TX
76240-3573
US

V. Phone/Fax

Practice location:
  • Phone: 940-612-8750
  • Fax: 940-668-2663
Mailing address:
  • Phone: 940-612-8750
  • Fax: 940-668-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS6325
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: