Healthcare Provider Details

I. General information

NPI: 1376609651
Provider Name (Legal Business Name): DENNIS I WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 S EASON BLVD
TUPELO MS
38801-6540
US

IV. Provider business mailing address

PO BOX 3970
TUPELO MS
38803-3970
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-4905
  • Fax: 662-377-4906
Mailing address:
  • Phone: 662-377-4905
  • Fax: 662-377-4906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number05699
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: