Provider Demographics
NPI:1184674434
Name:WAINWRIGHT, NEIL D (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:D
Last Name:WAINWRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27 MONTEBELLO RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1236
Mailing Address - Country:US
Mailing Address - Phone:719-545-1530
Mailing Address - Fax:719-545-2899
Practice Address - Street 1:27 MONTEBELLO RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1236
Practice Address - Country:US
Practice Address - Phone:719-545-1530
Practice Address - Fax:719-545-2899
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16094207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01160944Medicaid
COK2088OtherANTHEM
COK2088OtherFEDERAL BCBS
CO180014900OtherRAILROAD MEDICARE
CO608439600OtherUS DEPT LABOR WORK COMP
CO0452890001OtherMEDICARE DMERC
COCO6094OtherEYEMED EYECARE
CO608439600OtherUS DEPT LABOR WORK COMP
COK2088Medicare PIN
COD22984Medicare UPIN