Provider Demographics
NPI:1477622066
Name:WRIGHT, STEVEN WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:W
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO PA
Mailing Address - Street 1:1452 BELLAIRE LANE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905
Mailing Address - Country:US
Mailing Address - Phone:321-676-5151
Mailing Address - Fax:321-676-5165
Practice Address - Street 1:1452 BELLAIRE LANE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905
Practice Address - Country:US
Practice Address - Phone:321-676-5151
Practice Address - Fax:321-676-5165
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE32272Medicare UPIN
FL82602Medicare PIN