Individual
JIMMY C CHAN-PONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3030 HARDEN BLVD, LAKELAND, FL 33803-7952
(863) 284-5020
(863) 284-5192
Mailing address
1324 LAKELAND HILLS BLVD, ATTN: MANAGED CARE DEPT, LAKELAND, FL 33805-4543
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
ME64566
FL
207RP1001X
Pulmonary Disease Physician
Primary
ME0064566
FL
Other
Enumeration date
06/10/2005
Last updated
08/05/2022
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