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General NPI Number Information
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NPI Number | 1629289228
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Entity Type | Organization
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Legal Business Name | JOHN C.H. WANG, DO, PA
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4211 JOE RAMSEY BLVD E SUITE 203
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City | GREENVILLE
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State | TX
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Zip | 75401-7852
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Country | US
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Telephone | 903-408-5129
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Fax | 903-408-5121
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Provider Business Mailing Address
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Address Line | PO BOX 1943
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City | ROCKWALL
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State | TX
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Zip | 75087-2043
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Country | US
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Telephone | 903-408-5129
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Fax | 903-408-5121
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN C WANG
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Credential | DO
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Telephone | 903-408-5129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | L3866
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License Number State | TX
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