MEDICARE: DR. FAN WANG M.D., PH.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	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	:	1942263009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAN WANG M.D., PH.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	08/31/2020

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