MEDICARE: DR. GEORGE WANG 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
1	2084N0400X	Neurology Physician	29668	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
13	P00079658	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	752987075	OTHER	AZ	GREAT WEST
2	752987075	OTHER	AZ	LIFE WISE HEALTH CARE
3	1Z6331	OTHER	AZ	HEALTH NET
4	4229278-001	OTHER	AZ	CIGNA
5	AZ0712630	OTHER	AZ	BLUE CROSS & BLUE SHIELD
6	7080374	OTHER	AZ	AETNA
7	752987075	OTHER	AZ	HUMANA
8	A002	OTHER	AZ	TRICARE
9	358680100	OTHER	AZ	WORK COMP
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	752987075	OTHER	AZ	PACIFICARE
12	752987075	OTHER	AZ	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1851342828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE WANG M.D

Provider Business Mailing Address
First Line	:	2919 S ELLSWORTH RD
Second Line	:	SUITE 135
City	:	MESA
State	:	AZ
Zip	:	85212-2164
Country	:	US
Telephone Number	:	480-967-6888
Fax Number	:	480-967-6887

Provider Business Practice Location Address
First Line	:	2919 S ELLSWORTH RD
Second Line	:	SUITE 135
City	:	MESA
State	:	AZ
Zip	:	85212-2164
Country	:	US
Telephone Number	:	480-967-6888
Fax Number	:	480-967-6887

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	12/19/2007

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