Provider Demographics
NPI:1306823752
Name:WRIGHT, GEOFFREY L (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
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 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:STE 140
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6407
Practice Address - Country:US
Practice Address - Phone:806-355-5625
Practice Address - Fax:806-352-2245
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0307207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115755406Medicaid
TX8H0730OtherBCBS
TX040017691OtherRR MEDICARE
TX127330101OtherFIRSTCARE/SWHEALTHLIFE
TX115755406Medicaid
TXC23791Medicare UPIN