Provider Demographics
NPI:1841236510
Name:WRIGHT, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
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 1:800 E 20TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3859
Mailing Address - Country:US
Mailing Address - Phone:307-634-7711
Mailing Address - Fax:
Practice Address - Street 1:800 E 20TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3859
Practice Address - Country:US
Practice Address - Phone:307-634-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4495A2085R0202X
CO402102085R0202X
NE212542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY303605OtherBCBS OF WYOMING MRI
WY306015OtherBCBS OF WYOMING CRG
WY102371300Medicaid
CO91044958Medicaid
WY102371300Medicaid
CO91044958Medicaid
E29328Medicare UPIN
300052374Medicare ID - Type UnspecifiedRR MEDICARE CRG
WY303605Medicare ID - Type UnspecifiedWY MEDICARE MRI NUMBER
CO477208Medicare ID - Type UnspecifiedCO MEDICARE NUMBER