Healthcare Provider Details

I. General information

NPI: 1891759957
Provider Name (Legal Business Name): DALE C WRIGHT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE BOX 016960 M851
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1500 NW 12 AVE JMT- EAST 1007
MIAMI FL
33136-1028
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1111
  • Fax: 305-243-8470
Mailing address:
  • Phone: 305-243-4664
  • Fax: 305-243-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: