Provider Demographics
NPI:1033785134
Name:WRIGHT, BRYAN DAVID
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:DAVID
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 E 148TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-4254
Mailing Address - Country:US
Mailing Address - Phone:918-809-1465
Mailing Address - Fax:
Practice Address - Street 1:5818 E 148TH ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-4254
Practice Address - Country:US
Practice Address - Phone:918-809-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-29
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program