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NPI Code Detail

MEDICARE: PAUL WONG MD

MEDICARE: PAUL WONG MD
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
1207Q00000XFamily Medicine PhysicianLL84609SC

General Provider Information

NPI Number : 1154946424
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL WONG MD
Provider Business Mailing Address
First Line : 250 HARRISON ST FL 2
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-5094
Country : US
Telephone Number :
Fax Number : 321-267-2713
Provider Business Practice Location Address
First Line : 250 HARRISON ST FL 2ND
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-5094
Country : US
Telephone Number : 321-268-6868
Fax Number : 321-267-2713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2020
Last Update Date : 05/27/2025

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