Individual
DR. JEFFREY SOON BONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
451 SW BETHANY DR, SUITE 102, PORT ST LUCIE, FL 34986-1964
(630) 430-5085
Mailing address
2840 REYNOLDS DR, WINSTON SALEM, NC 27104-1904
(586) 949-4946
Taxonomy
Speciality
Code
Description
License number
State
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
Primary
5101016635
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5101016635
MICHIGAN LICENSE NUMBER
MI
Enumeration date
05/16/2007
Last updated
01/22/2013
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