Individual
SCOTT WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6810 STATE ROUTE 162 STE 100, MARYVILLE, IL 62062-8560
(618) 288-3616
(618) 288-3647
Mailing address
6810 STATE ROUTE 162 STE 100, MARYVILLE, IL 62062-8560
(618) 288-3616
(618) 288-3647
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036103837
IL
208600000X
Surgery Physician
2017031136
MO
2086S0129X
Vascular Surgery Physician
036103837
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036103837002
—
IL
Enumeration date
11/10/2006
Last updated
01/18/2023
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