Provider Demographics
NPI:1841212750
Name:WRIGHT, GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DEL PRADO BLVD N
Mailing Address - Street 2:SUITE 100
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:239-673-9694
Practice Address - Street 1:30 DEL PRADO BLVD N STE 100
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2734
Practice Address - Country:US
Practice Address - Phone:239-829-0099
Practice Address - Fax:239-673-9694
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73329208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253943800Medicaid
FL41846OtherBLUE CROSS BLUE SHIELD
FL5252066OtherAETNA
FL41846OtherBLUE CROSS BLUE SHIELD
FL253943800Medicaid
FL41846VMedicare PIN