Healthcare Provider Details

I. General information

NPI: 1578588901
Provider Name (Legal Business Name): KIM BRIAN WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 AIRPORT HEIGHTS DR STE 200
ANCHORAGE AK
99508-2969
US

IV. Provider business mailing address

1200 AIRPORT HEIGHTS DR STE 200
ANCHORAGE AK
99508-2969
US

V. Phone/Fax

Practice location:
  • Phone: 907-677-8737
  • Fax: 907-677-9731
Mailing address:
  • Phone: 907-677-8737
  • Fax: 907-677-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number5446
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5446
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: