Provider Demographics
NPI:1942393582
Name:WRIGHT, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
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 1:4 SHACKLEFORD PLAZA
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1844
Mailing Address - Country:US
Mailing Address - Phone:501-223-9991
Mailing Address - Fax:501-223-9925
Practice Address - Street 1:5201 NORTH SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-5312
Practice Address - Country:US
Practice Address - Phone:501-748-8000
Practice Address - Fax:501-748-8159
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7992207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121942001Medicaid
AR55223OtherARBCBS
F33806Medicare UPIN
AR121942001Medicaid