Provider Demographics
NPI:1568760411
Name:GARY WRIGHT MDPA
Entity Type:Organization
Organization Name:GARY WRIGHT MDPA
Other - Org Name:ALL WRIGHT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:239-896-5566
Mailing Address - Street 1:30 DEL PRADO BLVD N
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2705
Mailing Address - Country:US
Mailing Address - Phone:239-829-0099
Mailing Address - Fax:
Practice Address - Street 1:30 DEL PRADO BLVD N
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2705
Practice Address - Country:US
Practice Address - Phone:239-829-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY WRIGHT MDPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073329207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty