Provider Demographics
NPI:1619003613
Name:WIGHT, JOHN R (DVM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:WIGHT
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9317 WICKHAM WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5518
Mailing Address - Country:US
Mailing Address - Phone:407-925-3234
Mailing Address - Fax:407-386-3388
Practice Address - Street 1:9317 WICKHAM WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5518
Practice Address - Country:US
Practice Address - Phone:407-925-3234
Practice Address - Fax:407-386-3388
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVM6781174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian