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Individual

ELIZABETH ROUSE WONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
5100 OUTER LOOP, LOUISVILLE, KY 40219-4056
(502) 968-6226
(502) 966-5567
Mailing address
100 E LIBERTY ST, SUITE 800, LOUISVILLE, KY 40202-1434
(502) 968-6226
(502) 966-5567

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27435
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000479493
ANTHEM - NCMA
01
076693
SIHO/NORTON
KY
01
283734000
PASSPORT ADVANTAGE/NORTON
KY
01
50014617
PASSPORT/NORTON
KY
05
64274350
KY
01
P00386070
RAILROAD MEDICARE KY/NORT
KY
Enumeration date
06/08/2005
Last updated
03/21/2018
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