Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO2496 | FL |
NPI | 1003884917 |
---|---|
Provider Name | Dr. William S Wong |
First Address | Lakeland, FL 33803-1149 |
Second Address | Lakeland, FL 33803-1149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 27/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U63001 | (02) | FL |