Provider Demographics
NPI:1083646541
Name:WRIGHT, ROBERT JEFFREY (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEFFREY
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 1:800 W BOISE CIR STE 160
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4932
Mailing Address - Country:US
Mailing Address - Phone:189-949-1609
Mailing Address - Fax:918-403-6306
Practice Address - Street 1:800 W BOISE CIR STE 160
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4932
Practice Address - Country:US
Practice Address - Phone:918-994-9160
Practice Address - Fax:918-403-6306
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK1989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100089290AMedicaid
E45360Medicare UPIN
OK$$$$$$$$$RMedicare PIN