Provider Demographics
NPI:1396768883
Name:WRIGHT, PHILLIP G (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:G
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 1:8060 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4225
Mailing Address - Country:US
Mailing Address - Phone:510-638-3131
Mailing Address - Fax:510-638-3134
Practice Address - Street 1:8060 SURREY LN
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4225
Practice Address - Country:US
Practice Address - Phone:510-638-3131
Practice Address - Fax:510-638-3134
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40070Medicare UPIN
CA00G173892Medicare ID - Type Unspecified