Healthcare Provider Details

I. General information

NPI: 1609281930
Provider Name (Legal Business Name): FENG WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

IV. Provider business mailing address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-6155
  • Fax: 956-618-0451
Mailing address:
  • Phone: 956-687-6155
  • Fax: 956-618-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4162
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10051019
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: