MEDICARE: DR. ALAN DARE TONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0202X	Pediatric Cardiology Physician	2004030806	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003812504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN DARE TONG M.D.

Provider Business Mailing Address
First Line	:	1301 CONCORD TER
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-2843
Country	:	US
Telephone Number	:	800-243-3839
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 S NATIONAL AVE
Second Line	:	SUITE C 100
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-2607
Country	:	US
Telephone Number	:	417-447-4700
Fax Number	:	417-447-4701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	12/02/2011

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