Provider Demographics
NPI:1073583498
Name:WONG, FONG JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:FONG
Middle Name:JAMES
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 LAUREL RUN DR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8201
Mailing Address - Country:US
Mailing Address - Phone:352-369-1717
Mailing Address - Fax:352-351-8867
Practice Address - Street 1:1740 S.E 18TH STREET
Practice Address - Street 2:SUITE 801
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-351-8877
Practice Address - Fax:352-351-8867
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76024207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
K5067Medicare ID - Type Unspecified
FLE66121Medicare UPIN