Provider Demographics
NPI:1174769921
Name:CHRISTOPHER WONG MD PA
Entity type:Organization
Organization Name:CHRISTOPHER WONG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-760-2544
Mailing Address - Street 1:100 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE 213
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2888
Mailing Address - Country:US
Mailing Address - Phone:936-760-2544
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:STE 213
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2888
Practice Address - Country:US
Practice Address - Phone:936-760-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0245207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030226701Medicaid
TX0039BAMedicare PIN
TXF05460Medicare UPIN