Provider Demographics
NPI:1063434306
Name:WONG, CYRIL C (MD)
Entity type:Individual
Prefix:MR
First Name:CYRIL
Middle Name:C
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 15430
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-0118
Mailing Address - Country:US
Mailing Address - Phone:352-688-5700
Mailing Address - Fax:352-688-5548
Practice Address - Street 1:11009 HEARTH RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-3723
Practice Address - Country:US
Practice Address - Phone:352-688-5700
Practice Address - Fax:352-688-5548
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME66960208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376067700Medicaid
FL26182OtherBLUE CROSS BLUE SHIELD