Healthcare Provider Details

I. General information

NPI: 1396737326
Provider Name (Legal Business Name): GEORGE J. ANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E KINCAID ST SKAGIT REGIONAL CLINICS
MOUNT VERNON WA
98274-4127
US

IV. Provider business mailing address

1400 E KINCAID ST ATTN: CREDENTNIALING
MOUNT VERNON WA
98274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-428-2501
  • Fax: 360-428-2596
Mailing address:
  • Phone: 360-428-2500
  • Fax: 360-428-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number204597
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD2005-0584
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD60560473
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: