Provider Demographics
NPI:1275568636
Name:WRIGHT, LEON BERNARD (PA)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:BERNARD
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA
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 54987
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4987
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:9001 SUMMA AVENUE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3726
Practice Address - Country:US
Practice Address - Phone:225-761-5200
Practice Address - Fax:504-833-7796
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10633363A00000X
LAPA.A10633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03022766Medicaid
LA1706434Medicaid
LA380638YJA2Medicare PIN
LA1706434Medicaid
LA5C822P865Medicare PIN
LA523468YH3VMedicare PIN
MS03022766Medicaid
LA5DE56PG11Medicare PIN