Provider Demographics
NPI:1912982778
Name:WRIGHT, ROBERT M III (CPO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:WRIGHT
Suffix:III
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5413
Mailing Address - Country:US
Mailing Address - Phone:903-236-4488
Mailing Address - Fax:903-236-4607
Practice Address - Street 1:812 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5413
Practice Address - Country:US
Practice Address - Phone:903-236-4488
Practice Address - Fax:903-236-4607
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX519698OtherBLUE CROSS BLUE SHIELD
TX519698OtherBLUE CROSS BLUE SHIELD