Provider Demographics
NPI:1154331924
Name:JOHN WRIGLEY, M.D.,P.C.
Entity Type:Organization
Organization Name:JOHN WRIGLEY, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:WRIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-672-0091
Mailing Address - Street 1:1813 W HARVARD AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-2752
Mailing Address - Country:US
Mailing Address - Phone:541-672-0091
Mailing Address - Fax:541-672-0561
Practice Address - Street 1:1813 W HARVARD AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2752
Practice Address - Country:US
Practice Address - Phone:541-672-0091
Practice Address - Fax:541-672-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09993208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty