Provider Demographics
NPI:1295195824
Name:WRIGHT, MICAH RAY (DO)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:RAY
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4324
Mailing Address - Country:US
Mailing Address - Phone:405-694-9311
Mailing Address - Fax:
Practice Address - Street 1:2740 E 13TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4324
Practice Address - Country:US
Practice Address - Phone:405-694-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6281207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200716770AMedicaid
OK2G4732OtherMEDICARE