Organization
FAIRWAY PEDIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIAN WANG MD (OWNER)
(469) 855-2073
Entity
Organization
Contact information
Practice address
4100 FAIRWAY DR, SUITE 300, CARROLLTON, TX 75010-6525
(972) 492-8880
(972) 492-8818
Mailing address
4100 FAIRWAY DR, SUITE 300, CARROLLTON, TX 75010-6525
(972) 492-8880
(972) 492-8818
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K6737
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3079857-01
—
TX
Enumeration date
10/06/2012
Last updated
01/07/2013
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