Healthcare Provider Details

I. General information

NPI: 1811818362
Provider Name (Legal Business Name): WRIGHT DERMATOLOGY AND MOHS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E. 4TH STREET
PHOENIX OR
97535
US

IV. Provider business mailing address

105 E. 4TH STREET PO BOX 85638
PHOENIX OR
97535
US

V. Phone/Fax

Practice location:
  • Phone: 707-570-9111
  • Fax:
Mailing address:
  • Phone: 707-570-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN T. WRIGHT
Title or Position: OWNER / PHYSICIAN
Credential: MD
Phone: 707-570-9111