Healthcare Provider Details

I. General information

NPI: 1689647703
Provider Name (Legal Business Name): BRUCE R WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD 401
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

840 SE BISHOP BLVD 101
PULLMAN WA
99163-5502
US

V. Phone/Fax

Practice location:
  • Phone: 509-339-2394
  • Fax:
Mailing address:
  • Phone: 509-332-6139
  • Fax: 509-332-6579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00031811
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: