Individual
STACY WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-0630
Mailing address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-0630
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
BP10053998
TX
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
DR.0066287
CO
Other
Enumeration date
05/29/2015
Last updated
07/29/2021
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