Provider Demographics
NPI:1053308445
Name:WONG, ROBERT N (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BOMC ATTN HOSPITALISTS
Mailing Address - Street 2:1405 S. ALMA SCHOOL RD
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286
Mailing Address - Country:US
Mailing Address - Phone:480-256-7420
Mailing Address - Fax:480-646-3826
Practice Address - Street 1:BOMC ATTN HOSPITALISTS
Practice Address - Street 2:1405 S. ALMA SCHOOL RD
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:480-256-7420
Practice Address - Fax:480-646-3826
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-08-05
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25491207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG86583Medicare UPIN