Provider Demographics
NPI:1508801333
Name:WONG, GEORGE F III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:F
Last Name:WONG
Suffix:III
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 1:3982 E FORREST RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-9293
Mailing Address - Country:US
Mailing Address - Phone:417-886-8487
Mailing Address - Fax:
Practice Address - Street 1:3982 E FORREST RIDGE LN
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-9293
Practice Address - Country:US
Practice Address - Phone:417-886-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7J282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
107063OtherBLUE CROSS/BLUE SHIELD
MO202851200Medicaid
A98027Medicare UPIN
107063OtherBLUE CROSS/BLUE SHIELD