Provider Demographics
NPI:1649346347
Name:WRIGHT, ROBERT CHARLES (MD FACS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD FACS
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Other - Credentials:
Mailing Address - Street 1:208 17TH AVE SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4515
Mailing Address - Country:US
Mailing Address - Phone:253-840-1999
Mailing Address - Fax:253-445-4125
Practice Address - Street 1:208 17TH AVE SE
Practice Address - Street 2:SUITE 201
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4515
Practice Address - Country:US
Practice Address - Phone:253-840-1999
Practice Address - Fax:253-445-4125
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00025095208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124650Medicaid
WA1124650Medicaid