Healthcare Provider Details

I. General information

NPI: 1417935974
Provider Name (Legal Business Name): THOMAS F WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 MARKET CENTER BLVD STE 201
O FALLON MO
63368-8407
US

IV. Provider business mailing address

1630 MARKET CENTER BLVD STE 201
O FALLON MO
63368-8407
US

V. Phone/Fax

Practice location:
  • Phone: 636-397-4012
  • Fax: 636-278-1670
Mailing address:
  • Phone: 636-397-4012
  • Fax: 636-278-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number108025
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number108025
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: