Healthcare Provider Details

I. General information

NPI: 1669432290
Provider Name (Legal Business Name): GAIL LYNN WRIGHT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAIL LYNN SHAW MD

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7651 MEDICAL DR
HUDSON FL
34667-6594
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-9208
  • Fax: 727-868-6420
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-274-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME71516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: