Individual
BONNIE WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
902 LAKEVIEW AVE, SOUTHERN COLORADO FAMILY MEDICINE, PUEBLO, CO 81004-3798
(719) 557-5872
Mailing address
2116 WYOMING AVE, PUEBLO, CO 81004-3752
(206) 999-3950
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
TL-4526
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TL-4526
COLORADO TRAINING LICENSE NUMBER
CO
Enumeration date
07/17/2012
Last updated
07/17/2012
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