Provider Demographics
NPI:1427085117
Name:YANG, FAN (MD PHD)
Entity type:Individual
Prefix:DR
First Name:FAN
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:FAN
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12701 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8626
Mailing Address - Country:US
Mailing Address - Phone:239-768-0600
Mailing Address - Fax:239-768-1672
Practice Address - Street 1:12701 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8626
Practice Address - Country:US
Practice Address - Phone:239-768-0600
Practice Address - Fax:239-768-1672
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92711207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272095700Medicaid
FL02012Medicare ID - Type Unspecified
FL272095700Medicaid