Basic Information
| Provider Information | |||||||||
| NPI: | 1952338691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ONG | ||||||||
| FirstName: | GERMAINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 31235 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857511235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203244100 | ||||||||
| FaxNumber: | 5203241406 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 BURRO ALY | ||||||||
| Address2: | |||||||||
| City: | MORENCI | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855409647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9288659184 | ||||||||
| FaxNumber: | 9288659186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 05/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37698 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 37698 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207PE0004X | A180523-1 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 000528262002 | 01 | BCBS | OTHER | 01956394 | 05 | NY | MEDICAID | P00401068 | 01 | NY | RAILROAD | OTHER |