Provider Demographics
NPI:1053554717
Name:WANG, JUDY S (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:S
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-432-8336
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:600 N CATTLEMEN RD
Practice Address - Street 2:STE 200
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6422
Practice Address - Country:US
Practice Address - Phone:941-377-9993
Practice Address - Fax:941-343-0026
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123610207RX0202X, 207RX0202X
MDD74168207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014801200Medicaid