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Individual

DR. ALLEN WONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
323 E RIVERSIDE DR STE 224, EAGLE, ID 83616-6865
(208) 302-6000
(208) 302-6055
Mailing address
500 W FORT ST, ORANGE, BOISE, ID 83702-4501
(208) 422-1326

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
9700162
NC
207R00000X
Internal Medicine Physician
Primary
M-17388
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
891044W
NC
05
N00162
SC
Enumeration date
05/15/2006
Last updated
01/30/2025
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