Healthcare Provider Details

I. General information

NPI: 1316035058
Provider Name (Legal Business Name): RANDALL JOHN WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 802
HOUSTON TX
77030
US

IV. Provider business mailing address

6560 FANNIN ST STE 802
HOUSTON TX
77030-2726
US

V. Phone/Fax

Practice location:
  • Phone: 936-270-3900
  • Fax:
Mailing address:
  • Phone: 936-270-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberL7608
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberL7608
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD.024676
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: