Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 31235 | IA |
N | 207RP1001X | Pulmonary Disease | 036093604 | IL |
N | 207RP1001X | Pulmonary Disease | 31235 | IA |
NPI | 1013982610 |
---|---|
Provider Name | Dr. Humphrey Wong |
First Address | Davenport, IA 52807-7214 |
Second Address | Davenport, IA 52807-7209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0138024 | (05) | IA |
290008119 | RAILROAD MEDICARE (01) | IA |
290010030 | RAILROAD MEDICARE (01) | IL |
F43177 | (02) | IA |