Provider Demographics
NPI:1225080971
Name:WRIGHT, GARY L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7060
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7060
Mailing Address - Country:US
Mailing Address - Phone:480-444-2017
Mailing Address - Fax:480-545-7181
Practice Address - Street 1:3331 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2633
Practice Address - Country:US
Practice Address - Phone:480-545-1100
Practice Address - Fax:480-545-7181
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1638363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ318148001Medicaid
AZZ68644Medicare ID - Type Unspecified
AZP51681Medicare UPIN