Provider Demographics
NPI:1710926233
Name:WONG, RONALD D (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:D
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11765 WEST AVE
Mailing Address - Street 2:PMB 192
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2559
Mailing Address - Country:US
Mailing Address - Phone:210-924-7158
Mailing Address - Fax:210-924-4642
Practice Address - Street 1:102 PALO ALTO RD
Practice Address - Street 2:SUITE 125
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3758
Practice Address - Country:US
Practice Address - Phone:210-924-7158
Practice Address - Fax:210-924-4642
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
TXJ5950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF74754Medicare UPIN