Provider Demographics
NPI:1669572715
Name:WRIGHT, ANDREW LOGAN (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LOGAN
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 1:3800 W RAY RD STE 21
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-5940
Mailing Address - Country:US
Mailing Address - Phone:480-889-0508
Mailing Address - Fax:480-889-0511
Practice Address - Street 1:3800 W RAY RD STE 21
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5940
Practice Address - Country:US
Practice Address - Phone:480-889-0508
Practice Address - Fax:480-889-0511
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ418170Medicaid
AZG64476Medicare UPIN
AZ418170Medicaid