Provider Demographics
NPI:1467641811
Name:WIGHT, JUSTIN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:W
Last Name:WIGHT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:4712 E DYNAMITE BLVD
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-6243
Practice Address - Country:US
Practice Address - Phone:480-342-8711
Practice Address - Fax:480-342-7077
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2013-09-24
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Provider Licenses
StateLicense IDTaxonomies
AZ37182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine