Healthcare Provider Details

I. General information

NPI: 1467038083
Provider Name (Legal Business Name): WADE MILTON WRIGHT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18700 N 64TH DR STE 301
GLENDALE AZ
85308-7114
US

IV. Provider business mailing address

18700 N 64TH DR STE 301
GLENDALE AZ
85308-7114
US

V. Phone/Fax

Practice location:
  • Phone: 623-748-0145
  • Fax:
Mailing address:
  • Phone: 623-748-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number012704
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: