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General NPI Number Information
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NPI Number | 1770604688
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Entity Type | Organization
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Legal Business Name | ANTONIO WONG,MD & ASSOCIATES,PA
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 122 W CHAMPION ST
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City | EDINBURG
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State | TX
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Zip | 78539-4429
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Country | US
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Telephone | 956-287-1207
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Fax |
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Provider Business Mailing Address
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Address Line | 122 W CHAMPION ST
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City | EDINBURG
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State | TX
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Zip | 78539-4429
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Country | US
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Telephone | 956-287-1207
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER OWNER
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Name | ANTONIO WONG
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Credential | M.D.
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Telephone | 956-287-1207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | K1137
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License Number State | TX
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