Provider Demographics
NPI:1174547699
Name:WANG, ALUN R (MD)
Entity type:Individual
Prefix:
First Name:ALUN
Middle Name:R
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15259
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70175-5259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3715 PRYTANIA ST
Practice Address - Street 2:STE 306
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3761
Practice Address - Country:US
Practice Address - Phone:504-896-9023
Practice Address - Fax:504-896-9093
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13581R207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5H413CF36Medicare ID - Type Unspecified
H19658Medicare UPIN