MEDICARE: MR. WILLIAM ROBERT WRIGHT PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA 2074	FL

General Provider Information

NPI Number	:	1265652929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM ROBERT WRIGHT PAC

Provider Business Mailing Address
First Line	:	1014 CORNELL DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3412
Country	:	US
Telephone Number	:	850-763-4592
Fax Number	:	850-763-4999

Provider Business Practice Location Address
First Line	:	3230B E 15TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7423
Country	:	US
Telephone Number	:	850-763-4700
Fax Number	:	850-763-4999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. WILLIAM ROBERT WRIGHT PAC” Practice Location

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