Healthcare Provider Details

I. General information

NPI: 1568760411
Provider Name (Legal Business Name): GARY WRIGHT MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 DEL PRADO BLVD N
CAPE CORAL FL
33909-2705
US

IV. Provider business mailing address

30 DEL PRADO BLVD N
CAPE CORAL FL
33909-2705
US

V. Phone/Fax

Practice location:
  • Phone: 239-829-0099
  • Fax:
Mailing address:
  • Phone: 239-829-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0073329
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0073329
License Number StateFL

VIII. Authorized Official

Name: DR. GARY NORMAN WRIGHT II
Title or Position: OWNER
Credential: MD
Phone: 239-896-5566