Provider Demographics
NPI:1982389847
Name:WRIGHT, EDWARD DEAN JR
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:DEAN
Last Name:WRIGHT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 BRECKENRIDGE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2256
Mailing Address - Country:US
Mailing Address - Phone:606-622-4513
Mailing Address - Fax:
Practice Address - Street 1:561 BRECKENRIDGE ST APT 202
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2256
Practice Address - Country:US
Practice Address - Phone:606-622-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty