Healthcare Provider Details

I. General information

NPI: 1740462829
Provider Name (Legal Business Name): PERRYWRIGHT AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 RACE ST
FORT WORTH TX
76111-4116
US

IV. Provider business mailing address

3020 RACE ST
FORT WORTH TX
76111-4116
US

V. Phone/Fax

Practice location:
  • Phone: 817-838-9425
  • Fax:
Mailing address:
  • Phone: 817-838-9425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1197
License Number StateTX

VIII. Authorized Official

Name: DR. TERRY WRIGHT
Title or Position: OWNER
Credential: DPM
Phone: 817-838-9424