Provider Demographics
NPI:1336143353
Name:WRIGHT, RORY R (MD)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:R
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 1:575 W RIVER WOODS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1058
Mailing Address - Country:US
Mailing Address - Phone:414-332-6262
Mailing Address - Fax:414-332-0422
Practice Address - Street 1:525 W RIVER WOODS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1010
Practice Address - Country:US
Practice Address - Phone:414-332-6262
Practice Address - Fax:414-332-0422
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30707207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32005000Medicaid
200022953OtherRAILROAD MEDICARE
200022953OtherRAILROAD MEDICARE
000802724Medicare PIN
F73182Medicare UPIN