Provider Demographics
NPI:1700806312
Name:TZEWAN WONG MD PA
Entity Type:Organization
Organization Name:TZEWAN WONG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TZEWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-668-4484
Mailing Address - Street 1:10420 SW 77TH AVE
Mailing Address - Street 2:100
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3771
Mailing Address - Country:US
Mailing Address - Phone:305-668-4484
Mailing Address - Fax:305-668-4994
Practice Address - Street 1:10420 SW 77TH AVE
Practice Address - Street 2:100
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-3771
Practice Address - Country:US
Practice Address - Phone:305-668-4484
Practice Address - Fax:305-668-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042867100Medicaid
FL08766OtherB/C B/S
FL208767OtherAVMED
FLE49314Medicare UPIN
FL08766BMedicare ID - Type Unspecified