Basic Information
| Provider Information | |||||||||
| NPI: | 1508859083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 E ORCHARD RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036977463 | ||||||||
| FaxNumber: | 3037831200 | ||||||||
| Practice Location | |||||||||
| Address1: | 7800 E ORCHARD RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036977463 | ||||||||
| FaxNumber: | 3037831200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 25970 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 01259704 | 05 | CO | MEDICAID | P0076170 | 01 | CO | MEDICARE RAILROAD | OTHER |