Provider Demographics
NPI:1457866295
Name:WRIGHT, GUNNER BRYANT
Entity Type:Individual
Prefix:
First Name:GUNNER
Middle Name:BRYANT
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 1:4850 RAYMOND LABAUVE DR
Mailing Address - Street 2:
Mailing Address - City:BRUSLY
Mailing Address - State:LA
Mailing Address - Zip Code:70719-2334
Mailing Address - Country:US
Mailing Address - Phone:225-252-9395
Mailing Address - Fax:
Practice Address - Street 1:LSU ATHLETICS ADMINISTRATION BUILDING
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70803-0001
Practice Address - Country:US
Practice Address - Phone:225-578-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program