Provider Demographics
NPI:1528180635
Name:WRIGHT, STEPHEN ROBERT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7951 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5112
Mailing Address - Country:US
Mailing Address - Phone:954-985-9564
Mailing Address - Fax:
Practice Address - Street 1:10025 CLEARY BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1000
Practice Address - Country:US
Practice Address - Phone:954-382-1550
Practice Address - Fax:954-382-1250
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant