Individual
MARK WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
(602) 521-5800
(602) 521-5334
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
(602) 521-5800
(602) 521-5334
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
32916
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870304
—
AZ
Enumeration date
04/25/2006
Last updated
12/02/2016
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