Individual
JASON T WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 HARVARD STREET SE, UNIT J2-300, MINNEAPOLIS, MN 55455
(612) 273-6004
(612) 273-8459
Mailing address
UNIVERSITY OF MINNESOTA PHYSICIANS, 420 DELAWARE ST SE MMC 292, MINNEAPOLIS, MN 55455
(612) 273-6004
(612) 273-8459
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
47826
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0144508
—
MT
05
—
0594143
—
IA
01
—
1044141
PREFERREDONE
MN
01
—
132919
UCARE
MN
01
—
16-02032
MEDICA PRIMARY
MN
01
—
16-03682
MEDICA - CHOICE
MN
05
—
208670100
—
MN
01
—
2366354
AMERICA'S PPO
MN
01
—
238881
FAIRVIEW
MN
05
—
34666400
—
WI
01
—
615T6WO
BCBS MN
MN
01
—
B632
CHAMPUS
MN
01
—
HP52811
HEALTHPARTNERS
MN
Enumeration date
10/04/2006
Last updated
07/08/2007
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