Individual
DR. HUMPHREY WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1801 E 54TH ST, STE 100, DAVENPORT, IA 52807-7209
(563) 323-1229
(563) 323-8240
Mailing address
1801 E 54TH ST STE 100, DAVENPORT, IA 52807-7214
(563) 323-1229
(563) 323-8240
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
31235
IA
207RP1001X
Pulmonary Disease Physician
036093604
IL
207RP1001X
Pulmonary Disease Physician
31235
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0138024
—
IA
01
—
290008119
RAILROAD MEDICARE
IA
01
—
290010030
RAILROAD MEDICARE
IL
Enumeration date
02/17/2006
Last updated
04/26/2021
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