Healthcare Provider Details

I. General information

NPI: 1952338691
Provider Name (Legal Business Name): GERMAINE ONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BURRO ALY
MORENCI AZ
85540-9647
US

IV. Provider business mailing address

PO BOX 31235
TUCSON AZ
85751-1235
US

V. Phone/Fax

Practice location:
  • Phone: 928-865-9184
  • Fax: 928-865-9186
Mailing address:
  • Phone: 520-324-4100
  • Fax: 520-324-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA180523-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37698
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37698
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: