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NPI Code Detail

MEDICARE: DR. CHRISTINE W WAN M.D.

MEDICARE: DR. CHRISTINE W WAN M.D.
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
1207Q00000XFamily Medicine PhysicianK7933TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18J3981OTHERTXBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1609870377
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTINE W WAN M.D.
Provider Business Mailing Address
First Line : 4222 WENDOVER AVE
Second Line : SUITE 600
City : ODESSA
State : TX
Zip : 79762-5945
Country : US
Telephone Number : 432-552-5656
Fax Number : 432-552-0992
Provider Business Practice Location Address
First Line : 3051 E UNIVERSITY BLVD
Second Line :
City : ODESSA
State : TX
Zip : 79762-7902
Country : US
Telephone Number : 432-362-4376
Fax Number : 432-362-6308
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 11/12/2007

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Directions to “ DR. CHRISTINE W WAN M.D.” Practice Location

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