Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 036133523 | IL |
N | 208200000X | Surgeon | 4822 | OK |
N | 208600000X | Surgeon | 4822 | OK |
N | 208D00000X | General Practice Physician | 0102201956 | VA |
NPI | 1013177500 |
---|---|
Provider Name | Dr. Steve C Wang |
First Address | Bixby, OK 74008-1070 |
Second Address | Quincy, IL 62301-2834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 07/05/2014 |