Provider Demographics
NPI:1093796534
Name:WRIGHT, NATHAN J (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
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 1:5002 COWHORN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-9766
Mailing Address - Country:US
Mailing Address - Phone:903-614-3000
Mailing Address - Fax:903-614-3525
Practice Address - Street 1:2014 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4620
Practice Address - Country:US
Practice Address - Phone:903-792-2991
Practice Address - Fax:903-792-2995
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8422207R00000X
ARC8316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047793703Medicaid
AR97061OtherAR BCBS
AR128368001Medicaid
TX0039MHOtherBCBS OF TEXAS
TX047793703Medicaid
AR128368001Medicaid
TX8D3048Medicare ID - Type Unspecified