Provider Demographics
NPI:1144236183
Name:WONG, CHRISTOPHER M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
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:PO BOX 152193
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-8193
Mailing Address - Country:US
Mailing Address - Phone:817-676-9046
Mailing Address - Fax:817-265-3884
Practice Address - Street 1:609 MATLOCK CENTRE CIR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2535
Practice Address - Country:US
Practice Address - Phone:817-676-9046
Practice Address - Fax:817-265-3884
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3879207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151453102Medicaid
TX8K9321OtherBLUE CROSS BLUE SHIELD
TXP00140405OtherRAILROAD MEDICARE
TXPENDINGMedicaid
TX8B9466Medicare PIN