Provider Demographics
NPI:1033552831
Name:WRIGHT, DALLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DO
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 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-4262
Practice Address - Fax:903-531-5097
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6923207P00000X
TXR1325207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-0818167-051OtherTRICARE
TX8GX945OtherBCBS
TXP01876976OtherMEDICARE RAIL ROAD
TX75-1976930-005OtherTRICARE
TX374305601Medicaid
TX374305602Medicaid
TX581283YS6POtherMEDICARE
TX581283YS6VOtherMEDICARE
TX75-0818167-015OtherTRICARE
TX75-0818167-044OtherTRICARE
TX75-0818167-048OtherTRICARE
TXP01877173OtherMEDICARE RAIL ROAD