Provider Demographics
NPI:1841393949
Name:WRIGHT, CHESTER (MD)
Entity Type:Individual
Prefix:MR
First Name:CHESTER
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 1:7020 SMOKE RANCH RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3331
Mailing Address - Country:US
Mailing Address - Phone:702-796-3847
Mailing Address - Fax:702-341-6379
Practice Address - Street 1:7020 SMOKE RANCH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3331
Practice Address - Country:US
Practice Address - Phone:702-796-3847
Practice Address - Fax:702-341-6379
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-04-12
Deactivation Date:2021-03-07
Deactivation Code:
Reactivation Date:2021-04-12
Provider Licenses
StateLicense IDTaxonomies
MT11098207R00000X
NV20699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0154401Medicaid
MT011000140Medicare PIN
MT0154401Medicaid