Healthcare Provider Details

I. General information

NPI: 1356300743
Provider Name (Legal Business Name): JEFFREY ALLEN WRIGHTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 N TENAYA WAY STE 310
LAS VEGAS NV
89128-0642
US

IV. Provider business mailing address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-3547
  • Fax: 702-852-0559
Mailing address:
  • Phone: 702-216-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number5042
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: