Healthcare Provider Details

I. General information

NPI: 1598228157
Provider Name (Legal Business Name): JASON H WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR RM 714
MOBILE AL
36617-2300
US

IV. Provider business mailing address

2451 UNIVERSITY HOSPITAL DR RM 714
MOBILE AL
36617-2300
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7207
  • Fax: 251-471-7468
Mailing address:
  • Phone: 251-471-7207
  • Fax: 251-471-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101270185
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.49117
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: