Provider Demographics
NPI:1356345821
Name:ONG, STACY EILEEN (MD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:EILEEN
Last Name:ONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 HESTERS CROSSING RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-8027
Mailing Address - Country:US
Mailing Address - Phone:512-238-0762
Mailing Address - Fax:
Practice Address - Street 1:970 HESTERS CROSSING RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-8027
Practice Address - Country:US
Practice Address - Phone:512-238-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7826208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX882889Medicare ID - Type Unspecified
TXH27308Medicare UPIN