Individual
JEN WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3500 E FRANK PHILLIPS BLVD, BARTLESVILLE, OK 74006-2411
(918) 333-7200
Mailing address
4500 S GARNETT RD, STE 300, TULSA, OK 74146-5229
(770) 514-2773
(855) 917-2077
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
04-26325
KS
2085R0202X
Diagnostic Radiology Physician
Primary
19751
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100019560A
—
OK
05
—
100312770A
—
KS
Enumeration date
06/16/2006
Last updated
03/29/2017
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