Healthcare Provider Details

I. General information

NPI: 1770500209
Provider Name (Legal Business Name): NEILL MARSHALL WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR STE 125
SAINT LOUIS MO
63141-8663
US

IV. Provider business mailing address

12855 N 40 DR STE 125
SAINT LOUIS MO
63141-8663
US

V. Phone/Fax

Practice location:
  • Phone: 314-806-1770
  • Fax:
Mailing address:
  • Phone: 314-806-1770
  • Fax: 314-558-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036152559
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number119477
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: