Provider Demographics
NPI:1548217870
Name:WRIGHT, WILLIAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1337 S SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2046
Mailing Address - Country:US
Mailing Address - Phone:417-967-5639
Mailing Address - Fax:417-967-5667
Practice Address - Street 1:1337 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2046
Practice Address - Country:US
Practice Address - Phone:417-967-5639
Practice Address - Fax:417-967-5667
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002022068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO594000606OtherRH MEDICAID (GROUP)
MO26-8526OtherRH MEDICARE (GROUP)
MO503835001OtherMEDICAID (GROUP)
MO268535OtherRH MEDICARE (GROUP)
MO26D1009687OtherCLIA #
MO1548217870Medicaid
MO205995608Medicaid
MO597780303OtherRH MEDICAID (GROUP)
MO205995608Medicaid
MO121690003Medicare PIN
MO26D1009687OtherCLIA #
MO1548217870Medicaid
MO268526Medicare Oscar/Certification