MEDICARE: RYAN K WONG 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	207WX0107X	Retina Specialist (Ophthalmology) Physician	50496	AZ

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

General Provider Information

NPI Number	:	1922234798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN K WONG M.D.

Provider Business Mailing Address
First Line	:	6585 N. ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5611
Country	:	US
Telephone Number	:	520-742-7444
Fax Number	:

Provider Business Practice Location Address
First Line	:	6585 N. ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5611
Country	:	US
Telephone Number	:	520-742-7444
Fax Number	:

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

Provider Enumeration Date	:	06/05/2009
Last Update Date	:	04/06/2017

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