Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | ME123610 | FL |
NPI | 1053554717 |
---|---|
Provider Name | Dr. Judy S Wang |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Sarasota, FL 34232-6422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2009 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014801200 | (05) | FL |