Provider Demographics
NPI:1598082505
Name:FONG, JUDY (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:FONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 NW 58TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4423
Mailing Address - Country:US
Mailing Address - Phone:405-943-6288
Mailing Address - Fax:405-942-0866
Practice Address - Street 1:3617 NW 58TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4423
Practice Address - Country:US
Practice Address - Phone:405-943-6288
Practice Address - Fax:405-942-0866
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274636207V00000X
OK30906207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology