Basic Information
| Provider Information | |||||||||
| NPI: | 1235513599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | JIASHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W LEOTA ST | ||||||||
| Address2: | |||||||||
| City: | NORTH PLATTE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691016525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3085688000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 601 W LEOTA ST | ||||||||
| Address2: | |||||||||
| City: | NORTH PLATTE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 69101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3085688000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2015 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 30961 | NE | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.