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General NPI Number Information
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NPI Number | 1912954355
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Entity Type | Individual
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Provider Name | GLENROY WONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 6766 FOREST HILL BLVD
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City | GREENACRES
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State | FL
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Zip | 33413-3321
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Country | US
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Telephone | 561-966-0015
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Fax | 561-966-3911
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 400
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City | MIAMI
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State | FL
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Zip | 33126-2051
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Country | US
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Telephone | 305-500-2000
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 47449
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License Number State | FL
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