Provider Demographics
NPI:1548356975
Name:WONG, GREGORY J (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3857 E ALOE PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-0021
Mailing Address - Country:US
Mailing Address - Phone:602-796-8263
Mailing Address - Fax:480-324-5459
Practice Address - Street 1:10204 W HAPPY VALLEY PKWY STE 106B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2880
Practice Address - Country:US
Practice Address - Phone:480-631-4800
Practice Address - Fax:480-631-4801
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ21991207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ342600Medicaid
27816Medicare ID - Type Unspecified
AZ342600Medicaid