Healthcare Provider Details

I. General information

NPI: 1063815751
Provider Name (Legal Business Name): WRIGHT STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 COLONEL GLENN HWY
DAYTON OH
45435-0001
US

IV. Provider business mailing address

3640 COLONEL GLENN HWY
DAYTON OH
45435-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-245-7551
  • Fax:
Mailing address:
  • Phone: 937-245-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON FRANKLIN
Title or Position: ASSISTANT AD
Credential:
Phone: 937-245-7551