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General NPI Number Information
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NPI Number | 1255392791
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Entity Type | Individual
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Provider Name | DENNIS PAUL MONG
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 36000 DARNALL LOOP
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City | FORT HOOD
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State | TX
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Zip | 76544-5095
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Country | US
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Telephone | 254-702-5149
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Fax |
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Provider Business Mailing Address
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Address Line | 400 OVERLOOK DR NE
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City | WARREN
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State | OH
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Zip | 44483-5653
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Country | US
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Telephone | 254-947-8802
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 36077
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 266598
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License Number State | NY
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