Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 2004030806 | MO |
NPI | 1003812504 |
---|---|
Provider Name | Dr. Alan Dare Tong |
First Address | Sunrise, FL 33323-2843 |
Second Address | Springfield, MO 65810-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 02/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200316950A | (05) | KS |
209220805 | (05) | MO |
F87234 | (02) | MO |