MEDICARE: FAN WANG MD PHD OB GYN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	M2236	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003046541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAN WANG MD PHD OB GYN PLLC

Provider Business Mailing Address
First Line	:	6 WINDSOR PL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3900
Country	:	US
Telephone Number	:	713-884-8887
Fax Number	:	713-884-8480

Provider Business Practice Location Address
First Line	:	6671 SOUTHWEST FWY STE 320
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2220
Country	:	US
Telephone Number	:	713-884-8887
Fax Number	:	713-884-8480

Authorized Official
Title or Position	:	OWNER
Name	:	FAN WANG
Credential	:	MD, PHD
Telephone Number	:	832-782-3777

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	08/31/2020

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