Provider Demographics
NPI:1659557171
Name:WRIGHT, ETHAN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:JOSEPH
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ETHAN
Other - Middle Name:JOSEPH
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0444
Mailing Address - Country:US
Mailing Address - Phone:870-701-5119
Mailing Address - Fax:
Practice Address - Street 1:2943 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-6535
Practice Address - Country:US
Practice Address - Phone:870-424-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ART2008-002207W00000X
ARE5537207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168500001Medicaid