Healthcare Provider Details

I. General information

NPI: 1932193034
Provider Name (Legal Business Name): RALPH J WRIGHT III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 W 2ND PL #SUITE 150
LAKEWOOD CO
80228-1573
US

IV. Provider business mailing address

7951 E MAPLEWOOD AVE STE 300
GREENWOOD VILLAGE CO
80111-4726
US

V. Phone/Fax

Practice location:
  • Phone: 303-763-4020
  • Fax: 303-763-4039
Mailing address:
  • Phone: 303-930-7800
  • Fax: 303-930-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35063013
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number33578
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number49811
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: