Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD10961R | LA |
N | 208600000X | Surgeon | MD10961R | LA |
Y | 208200000X | Surgeon | R3617 | TX |
Y | 208600000X | Surgeon | R3617 | TX |
N | 2086X0206X | Surgical Oncologist | 10961R | LA |
N | 2086X0206X | Surgical Oncologist | R3617 | TX |
NPI | 1295826774 |
---|---|
Provider Name | Yi-Zarn Wang |
First Address | Odessa, TX 79763-4206 |
Second Address | Odessa, TX 79763-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 27/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05334356 | (05) | MS |
1995606 | (05) | LA |
F92906 | (02) | LA |