Healthcare Provider Details

I. General information

NPI: 1700806312
Provider Name (Legal Business Name): TZEWAN WONG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10420 SW 77TH AVE 100
PINECREST FL
33156-3771
US

IV. Provider business mailing address

10420 SW 77TH AVE 100
PINECREST FL
33156-3771
US

V. Phone/Fax

Practice location:
  • Phone: 305-668-4484
  • Fax: 305-668-4994
Mailing address:
  • Phone: 305-668-4484
  • Fax: 305-668-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0054738
License Number StateFL

VIII. Authorized Official

Name: DR. TZEWAN WONG
Title or Position: DOCTOR
Credential: MD
Phone: 305-668-4484