Provider Demographics
NPI:1831105311
Name:HONG, BO (MD)
Entity Type:Individual
Prefix:DR
First Name:BO
Middle Name:
Last Name:HONG
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 1:1899 EIDER CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4537
Mailing Address - Country:US
Mailing Address - Phone:850-219-7640
Mailing Address - Fax:850-942-6622
Practice Address - Street 1:1899 EIDER CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4537
Practice Address - Country:US
Practice Address - Phone:850-219-7640
Practice Address - Fax:850-942-6622
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057989207ZP0102X
FLME96743207ZP0102X
ALMD27504207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I65029Medicare UPIN