Basic Information
| Provider Information | |||||||||
| NPI: | 1982655403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | Z. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WANG | ||||||||
| OtherFirstName: | GEORGE | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3181 SW SAM JACKSON PARK RD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972393011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034948311 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037886911 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207R00000X | 35-08-1700-W | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DR.0052439 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD178859 | OR | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 01080593 | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | M-13428 | ID | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | DR.0052439 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 42978319 | 05 | CO | MEDICAID | P01208858 | 01 | CO | RAILROAD MEDICARE | OTHER | 2350745 | 05 | OH | MEDICAID | MD178859 | 01 | OR | OREGON MEDICAL LICENSE | OTHER |