Provider Demographics
NPI:1508972290
Name:WRIGHT, DALE R V (DPM)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:WRIGHT
Suffix:V
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S SHORE CTR W 103E
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:510-521-0441
Mailing Address - Fax:510-521-7473
Practice Address - Street 1:501 S SHORE CENTER W 103E
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2972
Practice Address - Country:US
Practice Address - Phone:510-521-0441
Practice Address - Fax:510-521-7473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E18670213E00000X
CAE1867213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E18670Medicaid
CA000E18670Medicare ID - Type UnspecifiedMEDICARE NUMBER
CA000E18670Medicaid