Provider Demographics
NPI:1336453307
Name:MERCED GENERAL SURGERY INC
Entity Type:Organization
Organization Name:MERCED GENERAL SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-384-8111
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112472208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty