Provider Demographics
NPI:1215257779
Name:WONG, RONNIE Q (MD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:Q
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 VONDERBURG DR
Mailing Address - Street 2:STE 311W
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5978
Mailing Address - Country:US
Mailing Address - Phone:813-654-2445
Mailing Address - Fax:813-654-9885
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:STE 311W
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5978
Practice Address - Country:US
Practice Address - Phone:813-654-2445
Practice Address - Fax:813-654-9885
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2016-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME125417207Q00000X
PAMD449745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIS751ZMedicare PIN