Individual
ANGUS WILFONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-0970
(602) 933-4253
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
(602) 933-1820
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
J0413
TX
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
53110
AZ
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
J0413
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033783402
—
TX
Enumeration date
10/17/2006
Last updated
04/04/2018
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