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NPI Code Detail

MEDICARE: ROBERT WILLLIAM WING MD

MEDICARE: ROBERT WILLLIAM WING 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
1207W00000XOphthalmology Physician166287 1205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
159266629001/1945OTHERUTBLUE CROSS ID NUMBER

General Provider Information

NPI Number : 1629064027
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT WILLLIAM WING MD
Provider Business Mailing Address
First Line : 4360 WASHINGTON BLVD
Second Line :
City : OGDEN
State : UT
Zip : 84403-1866
Country : US
Telephone Number : 801-476-0494
Fax Number : 801-476-0067
Provider Business Practice Location Address
First Line : 4360 WASHINGTON BLVD
Second Line :
City : OGDEN
State : UT
Zip : 84403-1866
Country : US
Telephone Number : 801-476-0494
Fax Number : 801-476-0067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 10/08/2014

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