Provider Demographics
NPI:1649414061
Name:WRIGHT, JONATHAN LEE (SFA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LEE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:SFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-7430
Mailing Address - Country:US
Mailing Address - Phone:214-681-7603
Mailing Address - Fax:
Practice Address - Street 1:3144 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189
Practice Address - Country:US
Practice Address - Phone:214-681-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00352246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant