Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 29480 | NE |
NPI | 1740670728 |
---|---|
Provider Name | Dr. Stephen Wong |
First Address | Joint Base Lewis Mcchord, WA 98431-1000 |
Second Address | Fort Hood, TX 76544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2015 |
Last Update Date | 24/07/2020 |