Individual
MISS DARA ROSALIE WANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17218 PRESTON RD STE 2000, DALLAS, TX 75252-4018
(877) 866-7123
(855) 855-2792
Mailing address
PO BOX 742712, ATLANTA, GA 30374-2712
(877) 866-7123
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
P5904
TX
207R00000X
Internal Medicine Physician
Primary
P5904
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331411401
—
TX
05
—
331411403
—
TX
01
—
8DU638
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/09/2010
Last updated
06/14/2023
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