Healthcare Provider Details

I. General information

NPI: 1356345821
Provider Name (Legal Business Name): STACY EILEEN ONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 HESTERS CROSSING RD SUITE 101
ROUND ROCK TX
78681-8027
US

IV. Provider business mailing address

970 HESTERS CROSSING RD SUITE 101
ROUND ROCK TX
78681-8027
US

V. Phone/Fax

Practice location:
  • Phone: 512-238-0762
  • Fax:
Mailing address:
  • Phone: 512-238-0762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberJ7826
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: