Provider Demographics
NPI:1306800727
Name:WONG, PHILIP WONG (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:WONG
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 SUN N LAKE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2171
Mailing Address - Country:US
Mailing Address - Phone:863-382-1663
Mailing Address - Fax:863-386-0162
Practice Address - Street 1:4325 SUN N LAKE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2171
Practice Address - Country:US
Practice Address - Phone:863-382-1663
Practice Address - Fax:863-386-0162
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10496207RP1001X
TXM6468207RP1001X
MS17471207RP1001X
NY238898207RP1001X
CAC52602207RP1001X
NV11841207RP1001X
FLME99701207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279273700Medicaid
MS0125040Medicaid
MS0125040Medicaid
MSH54541Medicare UPIN
MS290000090Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER