Healthcare Provider Details

I. General information

NPI: 1578545117
Provider Name (Legal Business Name): DAVID J WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE
STAYTON OR
97383-1311
US

IV. Provider business mailing address

PO BOX 806
CORVALLIS OR
97339-0806
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-2175
  • Fax:
Mailing address:
  • Phone: 541-758-5047
  • Fax: 541-758-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD07832
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: