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Organization

LARRY T. WONG, D.O., P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LARRY T WONG D.O. (PHYSICIAN)
(850) 215-1080
Entity
Organization

Contact information

Practice address
502 N MACARTHUR AVE, SUITE C, PANAMA CITY, FL 32401-3654
(850) 215-1080
(850) 215-1086
Mailing address
502 N MACARTHUR AVE, SUITE C, PANAMA CITY, FL 32401-3654
(850) 215-1080
(850) 215-1086

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
OS9154
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
270357200
FL
01
48027
BLUE CROSS/BLUE SHIELD
01
48027Y
MEDICARE PROVIDER NUMBER
Enumeration date
03/28/2008
Last updated
10/15/2012
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