Healthcare Provider Details

I. General information

NPI: 1275562795
Provider Name (Legal Business Name): CRAIG L WRIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12442 SW SCHOLLS FERRY RD STE 100
TIGARD OR
97223-3396
US

IV. Provider business mailing address

PO BOX 13994
PORTLAND OR
97213-0994
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-9900
  • Fax: 503-216-9266
Mailing address:
  • Phone: 503-215-6464
  • Fax: 503-215-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24906
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: