Wayland Ben Fong, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

M3984 Issued in ID

Practice address

808 La Cassia Dr
Boise, ID 83705-2253

Phone

(208) 343-6495

Fax

(208) 343-6496

NPI assigned

Jul 1, 2006

Last updated

Dec 1, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291161600000",
    "number": "1568491850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 LA CASSIA DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837052253",
            "telephone_number": "208-343-6495",
            "fax_number": "208-343-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 LA CASSIA DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837052253",
            "telephone_number": "208-343-6495",
            "fax_number": "208-343-6496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONG",
        "first_name": "WAYLAND",
        "middle_name": "BEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-01",
        "last_updated": "2010-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M3984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Charles Fogg II
• Jarom B Fogle, PHARMD
• Jennifer Fogle
• Diania Marie Folkes
• Megan Follett, RDN
• Steven J Fonken, MD
• Aaron Fontaine
• Shaundra Renee Fontaine, RN, APRN, CNM
• Matthew Fonte, MD
• Taylor Fontenot, RN

• Internal Medicine Physician in Boise, ID
• Providers in Boise, ID by specialty
• Internal Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.