Provider Demographics
NPI:1831300284
Name:WONG, PETER LAP (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:LAP
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2657
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0657
Mailing Address - Country:US
Mailing Address - Phone:209-384-8111
Mailing Address - Fax:209-384-8112
Practice Address - Street 1:3351 M ST
Practice Address - Street 2:105
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2700
Practice Address - Country:US
Practice Address - Phone:209-384-8111
Practice Address - Fax:209-384-8112
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112472208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery