Provider Demographics
NPI:1407226129
Name:WRIGHT, CLIFTON
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MAIN ST
Mailing Address - Street 2:STE1299
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4327
Mailing Address - Country:US
Mailing Address - Phone:214-760-1661
Mailing Address - Fax:214-760-1667
Practice Address - Street 1:2201 MAIN ST
Practice Address - Street 2:STE1299
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4327
Practice Address - Country:US
Practice Address - Phone:214-760-1661
Practice Address - Fax:214-760-1667
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR33794247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist