Individual
DR. MICHAEL FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3240 NE 3RD AVE, CAMAS, WA 98607-2408
(360) 729-8234
(360) 729-1337
Mailing address
315 S OSTEOPATHY AVE, KIRKSVILLE, MO 63501-6401
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OP61319260
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200072106
—
MO
Enumeration date
04/03/2016
Last updated
09/07/2022
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