Basic Information
Provider Information
NPI: 1841670536
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ONG
FirstName: LUEI
MiddleName: WERN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 HAWKINS DR
Address2: DEPARTMENT OF FAMILY MEDICINE
City: IOWA CITY
State: IA
PostalCode: 522421009
CountryCode: US
TelephoneNumber: 3193847000
FaxNumber: 3193847822
Practice Location
Address1: 110 LIBERTY ST
Address2:  
City: BROCKTON
State: MA
PostalCode: 023015521
CountryCode: US
TelephoneNumber: 5088940400
FaxNumber: 5088940332
Other Information
ProviderEnumerationDate: 06/08/2015
LastUpdateDate: 08/16/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XR-10300IAN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X274541MAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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