Provider Demographics
NPI:1376506113
Name:WRIGHT, MARSHALL LYNN (DPM)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:LYNN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 POLO TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7577
Mailing Address - Country:US
Mailing Address - Phone:817-514-7784
Mailing Address - Fax:
Practice Address - Street 1:777 E WHEATLAND RD
Practice Address - Street 2:SUITE 107
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4918
Practice Address - Country:US
Practice Address - Phone:972-298-8100
Practice Address - Fax:972-780-0798
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0921213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018787402Medicaid
TX8A0444Medicare ID - Type Unspecified
TXT16753Medicare UPIN