Provider Demographics
NPI:1417932179
Name:WRIGHT, KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
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 1:525 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1206
Mailing Address - Country:US
Mailing Address - Phone:319-363-8303
Mailing Address - Fax:319-364-4659
Practice Address - Street 1:525 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1206
Practice Address - Country:US
Practice Address - Phone:319-363-8303
Practice Address - Fax:319-364-4659
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24761207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0031005Medicaid
IA22722OtherWELLMARK BC/BS
IAA02676Medicare UPIN
IA22722Medicare ID - Type Unspecified