Provider Demographics
NPI:1184150138
Name:WONG, MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:WONG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7200 WYOMING SPRINGS DR
Mailing Address - Street 2:STE 600
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4305
Mailing Address - Country:US
Mailing Address - Phone:512-244-1995
Mailing Address - Fax:877-215-6813
Practice Address - Street 1:1402 W AVENUE H
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-5342
Practice Address - Country:US
Practice Address - Phone:254-771-8411
Practice Address - Fax:254-771-8407
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine