Organization
BURNT STORE FAMILY MEDICINE P L
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON WANG MD (OWNER)
(941) 505-0974
Entity
Organization
Contact information
Practice address
100 MADRID BLVD, SUITE 513, PUNTA GORDA, FL 33950-7968
(941) 505-0974
(941) 505-8517
Mailing address
100 MADRID BLVD, SUITE 513, PUNTA GORDA, FL 33950-7968
(941) 505-0974
(941) 505-8517
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0072508
FL
Other
Enumeration date
09/08/2010
Last updated
06/23/2011
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