Healthcare Provider Details

I. General information

NPI: 1922068220
Provider Name (Legal Business Name): TERRY WRIGHT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/29/2011
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: 817-838-9424
  • Fax: 817-838-9425
Mailing address:
  • Phone: 817-838-9424
  • Fax: 817-838-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1197
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: