Provider Demographics
NPI:1316035058
Name:WRIGHT, RANDALL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:JOHN
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 1:6560 FANNIN ST STE 802
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2726
Mailing Address - Country:US
Mailing Address - Phone:936-270-3900
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 802
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:936-270-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL76082084S0012X, 2084N0400X
LAMD.0246762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1184714867OtherTYPE 2 NPI
TX00106WOtherMEDICARE GRP PTAN HARRIS CO
TX8DH440OtherBCBSTX GRP PROV REC NUMBER
TX00659NOtherMEDICARE GRP PTAN # MONTGOMERY CO
TX166839402Medicaid
TX1184714867OtherTYPE 2 NPI
TX166839402Medicaid