Healthcare Provider Details

I. General information

NPI: 1083092837
Provider Name (Legal Business Name): JOSHUA WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD SHANDS HOSPITAL, ROOM 4102
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1600 SW ARCHER RD SHANDS HOSPITAL, ROOM 4102
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0239
  • Fax: 352-265-1107
Mailing address:
  • Phone: 352-265-0239
  • Fax: 352-265-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME140314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: