Provider Demographics
NPI:1386672103
Name:WONG, GEORGE C (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:C
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 1:1500 N DIXIE HWY
Mailing Address - Street 2:SUITE #201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2712
Mailing Address - Country:US
Mailing Address - Phone:561-659-6535
Mailing Address - Fax:561-659-2486
Practice Address - Street 1:1500 N DIXIE HWY
Practice Address - Street 2:SUITE #201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2712
Practice Address - Country:US
Practice Address - Phone:561-659-6535
Practice Address - Fax:561-659-2486
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054235207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052595200Medicaid
E83793Medicare UPIN
FL11970Medicare ID - Type Unspecified