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General NPI Number Information
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NPI Number | 1205076387
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Entity Type | Organization
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Legal Business Name | RUSSELLVILLE CARDIOLOGY CONSULTANTS, PA
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 106 S INGLEWOOD AVE
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-3353
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Country | US
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Telephone | 479-968-4311
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Fax | 479-968-4399
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Provider Business Mailing Address
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Address Line | 106 S INGLEWOOD AVE
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-3353
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Country | US
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Telephone | 479-968-4311
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Fax | 479-968-4399
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAI YUAN WANG
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Credential | MD
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Telephone | 479-968-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | E5291
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License Number State | AR
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