MEDICARE: JAMES ARTHUR MONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	27069	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	60001	OTHER		BCBS

General Provider Information

NPI Number	:	1114922580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ARTHUR MONG MD

Provider Business Mailing Address
First Line	:	4414 LAKE BOONE TRL
Second Line	:	STE 210
City	:	RALEIGH
State	:	NC
Zip	:	27607-7505
Country	:	US
Telephone Number	:	919-571-1040
Fax Number	:	919-781-0247

Provider Business Practice Location Address
First Line	:	4414 LAKE BOONE TRL
Second Line	:	STE 210
City	:	RALEIGH
State	:	NC
Zip	:	27607-7505
Country	:	US
Telephone Number	:	919-571-1040
Fax Number	:	919-781-0247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/07/2014

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