Provider Demographics
NPI:1467038083
Name:WRIGHT, WADE MILTON
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:MILTON
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 1:3017 W MOHAWK LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3116
Mailing Address - Country:US
Mailing Address - Phone:623-980-5786
Mailing Address - Fax:
Practice Address - Street 1:6525 W SACK DR STE 302
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7107
Practice Address - Country:US
Practice Address - Phone:623-561-7983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program