MEDICARE: STEVEN W. WRIGHT, D.O., P.A.

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	261Q00000X	Clinic/Center	OS4636	FL

General Provider Information

NPI Number	:	1679883466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN W. WRIGHT, D.O., P.A.

Provider Business Mailing Address
First Line	:	1452 BELLAIRE LN NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3902
Country	:	US
Telephone Number	:	321-676-5151
Fax Number	:	321-676-5165

Provider Business Practice Location Address
First Line	:	1452 BELLAIRE LN NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3902
Country	:	US
Telephone Number	:	321-676-5151
Fax Number	:	321-676-5165

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	STEVEN W WRIGHT
Credential	:	D.O.
Telephone Number	:	321-676-5151

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	10/14/2010

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