Healthcare Provider Details

I. General information

NPI: 1891755914
Provider Name (Legal Business Name): JAMES KIRK WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 CAROLINE ST
PORT ANGELES WA
98362
US

IV. Provider business mailing address

PO BOX 850
PORT ANGELES WA
98362-0146
US

V. Phone/Fax

Practice location:
  • Phone: 360-417-7433
  • Fax: 360-417-7003
Mailing address:
  • Phone: 360-417-7111
  • Fax: 360-417-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberMD00017556
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD00017556
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: