Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME124562 | FL |
N | 207RA0201X | Internist - Allergy & Immunology | ME124562 | FL |
NPI | 1427140177 |
---|---|
Provider Name | Sally Ong Dee |
First Address | Bridgeport, WV 26330-1175 |
Second Address | Orange City, FL 32763-8361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 30/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1842154000 | (05) | WV |