Healthcare Provider Details

I. General information

NPI: 1427012921
Provider Name (Legal Business Name): CHARLES JOHN WRIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 S SONCY RD STE 104
AMARILLO TX
79119-6405
US

IV. Provider business mailing address

367 S GULPH RD ATTN :IPM CREDENTIALING
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 806-398-3627
  • Fax: 806-351-7801
Mailing address:
  • Phone: 484-913-7467
  • Fax: 610-878-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG059721
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036-082040
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberN7599
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: