Healthcare Provider Details

I. General information

NPI: 1154645562
Provider Name (Legal Business Name): MICHAEL SPENCER GEORGE WRIGHT RPA, RT(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST RADIOLOGY DEPARTMENT
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1201 NW 16TH ST RADIOLOGY DEPARTMENT
MIAMI FL
33125-1624
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax: 305-575-7036
Mailing address:
  • Phone: 305-575-7000
  • Fax: 305-575-7036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number34228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: