Healthcare Provider Details

I. General information

NPI: 1912455247
Provider Name (Legal Business Name): CONRAD WRIGHT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 2022
APO AP
96264-2022
US

IV. Provider business mailing address

UNIT 2022
APO AP
96264-2022
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-9503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023033015
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: