Provider Demographics
NPI:1295778223
Name:WRIGHT, MARK B (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0587
Mailing Address - Country:US
Mailing Address - Phone:208-814-7400
Mailing Address - Fax:208-814-7491
Practice Address - Street 1:738 N COLLEGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3385
Practice Address - Country:US
Practice Address - Phone:208-814-7000
Practice Address - Fax:208-734-7294
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM8476207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP00654633OtherMCRR
ID806367000Medicaid
IDH60022Medicare UPIN
IDP00654633OtherMCRR