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Individual

TOM D. WANG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3303 SW BOND AVE, MAIL CODE: CH 5E, PORTLAND, OR 97239-4501
(503) 494-5678
Mailing address
3303 SW BOND AVE, MAIL CODE: CH 5E, PORTLAND, OR 97239-4501
(503) 494-5678

Taxonomy

Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
14868
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
055868
OR
Enumeration date
08/03/2006
Last updated
07/13/2007
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