Healthcare Provider Details

I. General information

NPI: 1174781231
Provider Name (Legal Business Name): WRIGHT B LAUTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MILLSAPS DR SUITE B
HATTIESBURG MS
39402-1587
US

IV. Provider business mailing address

109 MILLSAPS DR SUITE B
HATTIESBURG MS
39402-1587
US

V. Phone/Fax

Practice location:
  • Phone: 601-255-0736
  • Fax: 601-255-0735
Mailing address:
  • Phone: 601-255-0736
  • Fax: 601-255-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME109594
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number21600
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number29277
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number21600
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: