Provider Demographics
NPI:1255364857
Name:FONG JAMES WONG,M.D,P.A
Entity type:Organization
Organization Name:FONG JAMES WONG,M.D,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FONG
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-351-8877
Mailing Address - Street 1:1740 S.E 18TH STREET
Mailing Address - Street 2:UNIT 801
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5447
Mailing Address - Country:US
Mailing Address - Phone:352-351-8877
Mailing Address - Fax:352-351-8867
Practice Address - Street 1:1740 S.E 18TH STREET
Practice Address - Street 2:UNIT 801
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5447
Practice Address - Country:US
Practice Address - Phone:352-351-8877
Practice Address - Fax:352-351-8867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76024207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5067Medicare ID - Type Unspecified
E66121Medicare UPIN