Brian Wong
Pediatrics in Eagle, ID. Individual provider (NPI-1).
NPI number1124474960
StatusActive
Last updated in NPPESJun 2, 2025
Details
- NPI
- 1124474960
- Entity type
- Individual (NPI-1)
- Name
- Brian Wong
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 11, 2016
- Certification date
- Jun 2, 2025
- Last updated
- Jun 2, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | M-14689 | ID | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
3217 W Bavaria StEagle, ID 83616-5171
Phone 208-302-6200 · Fax 208-302-6245
Mailing address
Po Box 190930Boise, ID 83719-0930
Phone 208-367-5170
Other practice locations
3653 N Locust Grove Rd
Meridian, ID 83646-5924
Meridian, ID 83646-5924
Phone 208-338-6437
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- Laura Michelle McDermott, M.D.NPI 1942596606
- Alan Paul Miller, M.D.NPI 1659329928
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