Provider Demographics
NPI:1417578592
Name:ONG, DYLAN JUDE (MD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JUDE
Last Name:ONG
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 1:1329 SW 16 STREET 4TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3424
Mailing Address - Country:US
Mailing Address - Phone:352-594-4306
Mailing Address - Fax:352-265-7983
Practice Address - Street 1:1329 SW 16 STREET 4TH FLOOR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3424
Practice Address - Country:US
Practice Address - Phone:352-594-4306
Practice Address - Fax:352-265-7983
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program