Provider Demographics
NPI:1992792402
Name:WONG, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
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:PO BOX 16875
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6875
Mailing Address - Country:US
Mailing Address - Phone:281-491-0561
Mailing Address - Fax:281-491-0562
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:SUITE 581
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-491-0561
Practice Address - Fax:281-491-0562
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8421174400000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP089971B1Medicaid
TXP089971B1Medicaid
TXF36034Medicare UPIN