Provider Demographics
NPI:1043251564
Name:WRIGHT, SYDNEY THURMAN JR (MD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:THURMAN
Last Name:WRIGHT
Suffix:JR
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 1:57 POST ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5003
Mailing Address - Country:US
Mailing Address - Phone:415-661-5667
Mailing Address - Fax:415-337-1844
Practice Address - Street 1:57 POST ST
Practice Address - Street 2:STE 602
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-5023
Practice Address - Country:US
Practice Address - Phone:415-661-5667
Practice Address - Fax:415-337-1844
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0583492084P0800X
CAG279142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL683570Medicare ID - Type Unspecified
ILD15381Medicare UPIN