Provider Demographics
NPI:1932893419
Name:FUTTERER, JANE TSUNG-WEN WONG (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:TSUNG-WEN WONG
Last Name:FUTTERER
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 1:36 OAKLANDS AVENUE
Mailing Address - Street 2:HARBORNE
Mailing Address - City:BIRMINGHAM
Mailing Address - State:WEST MIDLANDS
Mailing Address - Zip Code:B17 9TU
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 E TEXAS ST STE 100
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3275
Practice Address - Country:US
Practice Address - Phone:504-977-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.021509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine