Healthcare Provider Details

I. General information

NPI: 1366149304
Provider Name (Legal Business Name): TAYLOR G WRIGHT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 S PROGRESS AVE STE 150
MERIDIAN ID
83642-5610
US

IV. Provider business mailing address

6405 S 3000 E STE 300
SALT LAKE CITY UT
84121-6977
US

V. Phone/Fax

Practice location:
  • Phone: 208-813-1958
  • Fax: 208-600-6905
Mailing address:
  • Phone: 801-266-3113
  • Fax: 801-266-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR G WRIGHT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 801-266-3113