Healthcare Provider Details

I. General information

NPI: 1386928489
Provider Name (Legal Business Name): EUNICE ANN HAI HUAT WONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E BROADWAY STE. 110
COLUMBIA MO
65201-8023
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE. 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8130
  • Fax: 573-815-8149
Mailing address:
  • Phone: 573-815-8130
  • Fax: 573-815-8149

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 Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2015038364
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: