Individual
TOM MONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 GARY ST, ALEXANDRIA, LA 71301-4230
(318) 442-1051
Mailing address
2801 GARY ST, ALEXANDRIA, LA 71301-4230
(318) 442-1051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15490
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1195952
—
LA
Enumeration date
06/26/2006
Last updated
02/04/2011
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