Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 20A10222 | CA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 4414 | AZ |
N | 2081P2900X | Pain Medicine | 20A10222 | CA |
Y | 2081P2900X | Pain Medicine | 4414 | AZ |
NPI | 1053492389 |
---|---|
Provider Name | Dr. Paul Wang |
First Address | Scottsdale, AZ 85254-2070 |
Second Address | Scottsdale, AZ 85254-2070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 06/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I63995 | (02) | AZ |