MEDICARE: ANDREW M WONG MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	ME59819	FL
2	207X00000X	Orthopaedic Surgery Physician	050854	GA
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	050854	GA
4	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	ME59819	FL

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

NPI Number	:	1407859226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW M WONG MD

Provider Business Mailing Address
First Line	:	3334 CAPITAL MEDICAL BLVD STE 400
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4470
Country	:	US
Telephone Number	:	850-877-8174
Fax Number	:	850-877-5636

Provider Business Practice Location Address
First Line	:	3334 CAPITAL MEDICAL BLVD STE 400
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4470
Country	:	US
Telephone Number	:	850-877-8174
Fax Number	:	850-877-5636

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/23/2021

3334 CAPITAL MEDICAL BLVD STE 400
TALLAHASSEE, FL
32308-4470

Practice Phone: 850-877-8174
Practice Fax: 844-261-6839

3334 CAPITAL MEDICAL BLVD , SUITE 400
TALLAHASSEE, FL
32308-4470