MEDICARE: DR. JENNIFER H WANG DPM

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	213ES0131X	Foot Surgery Podiatrist	1646	TX
2	213ES0131X	Foot Surgery Podiatrist	N005645	NY
3	213E00000X	Podiatrist	1646	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P00695818	OTHER	TX	RAILROAD
4	8CS732	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1619950565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER H WANG DPM

Provider Business Mailing Address
First Line	:	13502 PADDINGTON CIR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-1930
Country	:	US
Telephone Number	:	877-801-1188
Fax Number	:	888-592-3646

Provider Business Practice Location Address
First Line	:	13502 PADDINGTON CIR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-1930
Country	:	US
Telephone Number	:	877-801-1188
Fax Number	:	888-592-3646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	08/11/2014

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