Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 21345 | MA |
N | 213EG0000X | General Practice | 21345 | MA |
Y | 1223G0001X | General Practice | 24384 | TX |
Y | 213EG0000X | General Practice | 24384 | TX |
NPI | 1003845322 |
---|---|
Provider Name | Dr. Bo Wang |
First Address | Sugar Land, TX 77478-4930 |
Second Address | Sugar Land, TX 77478-4930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 19/09/2011 |