Provider Demographics
NPI:1528241304
Name:WILLIAM S WONG, D.P.M. P.A.
Entity type:Organization
Organization Name:WILLIAM S WONG, D.P.M. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:863-686-1081
Mailing Address - Street 1:927 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1149
Mailing Address - Country:US
Mailing Address - Phone:863-686-1081
Mailing Address - Fax:863-687-6333
Practice Address - Street 1:927 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1149
Practice Address - Country:US
Practice Address - Phone:863-686-1081
Practice Address - Fax:863-687-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2496213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480034954OtherRAILROAD MEDICARE
FL65427OtherBCBS
FL0292330OtherCIGNA HEALTHCARE
FL65427Medicare PIN
FLU63001Medicare UPIN
FL4760750001Medicare NSC