Provider Demographics
NPI:1033107875
Name:WRIGHT, CLARENCE DAVID (MD)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:DAVID
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-362-0153
Mailing Address - Fax:989-362-4683
Practice Address - Street 1:5939 N HURON RD
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-9710
Practice Address - Country:US
Practice Address - Phone:989-739-1441
Practice Address - Fax:989-739-6093
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2854238Medicaid
MI2854238Medicaid
MIC56012001Medicare ID - Type Unspecified