Provider Demographics
NPI:1275507477
Name:WRIGHT, TERRY LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEON
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:77 MILLARD ALLEN DR.
Mailing Address - City:LACKEY
Mailing Address - State:KY
Mailing Address - Zip Code:41643-0190
Mailing Address - Country:US
Mailing Address - Phone:606-358-2381
Mailing Address - Fax:606-358-2404
Practice Address - Street 1:77 MILLARD ALLEN DR E
Practice Address - Street 2:
Practice Address - City:LACKEY
Practice Address - State:KY
Practice Address - Zip Code:41643-0190
Practice Address - Country:US
Practice Address - Phone:606-358-2381
Practice Address - Fax:606-358-2404
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY18594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000631792OtherBCBS
KY64185945Medicaid
KY1276320Medicare PIN
KY000000631792OtherBCBS