Individual
DR. WAYLAND BEN FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
808 LA CASSIA DR, BOISE, ID 83705-2253
(208) 343-6495
(208) 343-6496
Mailing address
808 LA CASSIA DR, BOISE, ID 83705-2253
(208) 343-6495
(208) 343-6496
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M3984
ID
Other
Enumeration date
07/01/2006
Last updated
12/01/2010
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