Provider Demographics
NPI:1972563930
Name:WRIGHT, BYRON E (MD)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:E
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 1:925 HIGHLAND BLVD
Mailing Address - Street 2:STE 1100
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6900
Mailing Address - Country:US
Mailing Address - Phone:406-414-4550
Mailing Address - Fax:
Practice Address - Street 1:925 HIGHLAND BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6900
Practice Address - Country:US
Practice Address - Phone:406-414-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT700422086S0102X, 208600000X
WAMD000417842086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1972563930Medicaid
P00639875OtherRAILROAD MEDICARE
WA0236946OtherLABOR & INDUSTRIES
5206554OtherAETNA
7590WROtherASURIS NW HEALTH
ID808035400Medicaid
000010168124OtherBLUE SHIELD OF IDAHO
7590WROtherASURIS NW HEALTH