Provider Demographics
NPI:1902815483
Name:WRIGHT, ALLAN MACDONALD (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:MACDONALD
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2410 SAMARITAN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3909
Mailing Address - Country:US
Mailing Address - Phone:408-371-0390
Mailing Address - Fax:408-371-0462
Practice Address - Street 1:2410 SAMARITAN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3909
Practice Address - Country:US
Practice Address - Phone:408-371-0728
Practice Address - Fax:408-371-1164
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG530962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G530960Medicaid
A52445Medicare UPIN
CA00G530960Medicaid