MEDICARE: ARNOLD D FONG MD PA

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	207Q00000X	Family Medicine Physician	ME65011	FL

General Provider Information

NPI Number	:	1861661787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARNOLD D FONG MD PA

Provider Business Mailing Address
First Line	:	1102 A1A N
Second Line	:	SUITE 106
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-4098
Country	:	US
Telephone Number	:	904-280-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 A1A N
Second Line	:	SUITE 106
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-4098
Country	:	US
Telephone Number	:	904-280-8228
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	ARNOLD DOUGLAS FONG
Credential	:	M.D.
Telephone Number	:	904-280-8228

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	07/15/2008

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