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NPI Code Detail

MEDICARE: ROBERTA Y WANG MD

MEDICARE:   ROBERTA Y WANG  MD
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
1207V00000XObstetrics & Gynecology Physician6053973-1205UT

General Provider Information

NPI Number : 1861444929
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTA Y WANG MD
Provider Business Mailing Address
First Line : PO BOX 58859
Second Line :
City : SLC
State : UT
Zip : 84158-0859
Country : US
Telephone Number : 801-585-5172
Fax Number :
Provider Business Practice Location Address
First Line : 50 N MEDICAL DR
Second Line :
City : SLC
State : UT
Zip : 84132-0001
Country : US
Telephone Number : 801-581-2719
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 07/08/2007

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Directions to “ ROBERTA Y WANG MD” Practice Location

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