Healthcare Provider Details

I. General information

NPI: 1982845962
Provider Name (Legal Business Name): BENJAMIN MICHAEL WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GAUSE BLVD BOX 4
SLIDELL LA
70458-2939
US

IV. Provider business mailing address

2117 GIUFFRIAS AVE APT 20
METAIRIE LA
70001-6625
US

V. Phone/Fax

Practice location:
  • Phone: 985-280-8742
  • Fax:
Mailing address:
  • Phone: 504-957-6967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.204720
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD204720
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.20470
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: