Healthcare Provider Details

I. General information

NPI: 1336337062
Provider Name (Legal Business Name): WRIGHT ORTHOPEDIC SPORTS MEDICINE AND FITNESS INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 BEN FRANKLIN BLVD SUITE 140
DURHAM NC
27704-2167
US

IV. Provider business mailing address

4125 BEN FRANKLIN BLVD SUITE 140
DURHAM NC
27704-2167
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-9331
  • Fax: 919-471-6524
Mailing address:
  • Phone: 919-471-9331
  • Fax: 919-471-6524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19430
License Number StateNC

VIII. Authorized Official

Name: PAUL HARLAN WRIGHT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 919-471-9331