NPI 1124474960

Brian Wong

Practitioner Pediatrics Physician Eagle, ID

Practice location

Address: 3217 W Bavaria St, Eagle, ID 83616-5171
Phone: (208) 302-6200
Fax: (208) 302-6245
Mailing address: PO Box 190930, Boise, ID 83719-0930

Registered specialties (2)

Pediatrics Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208000000X Licence M-14689 (ID)

Other Pediatrics providers in Idaho →

Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X

Other Student in an Organized Health Care Education/Training Program providers in Idaho →

Registry record

NPI: 1124474960
Entity type: Individual
Sex (as registered): Male
NPI issued: 11 May 2016
Record last updated: 2 Jun 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.