Provider Demographics
NPI:1457644866
Name:MARK L. WRIGHT, M.D., P.A.
Entity Type:Organization
Organization Name:MARK L. WRIGHT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-237-7032
Mailing Address - Street 1:3316 CIRCLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6520
Mailing Address - Country:US
Mailing Address - Phone:817-283-8453
Mailing Address - Fax:
Practice Address - Street 1:3316 CIRCLEWOOD CT
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-6520
Practice Address - Country:US
Practice Address - Phone:817-283-8453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4810208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E40764Medicare UPIN