Healthcare Provider Details

I. General information

NPI: 1336143353
Provider Name (Legal Business Name): RORY R WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W RIVER WOODS PKWY STE 100
GLENDALE WI
53212-1010
US

IV. Provider business mailing address

575 W RIVER WOODS PKWY STE 100
GLENDALE WI
53212-1058
US

V. Phone/Fax

Practice location:
  • Phone: 414-332-6262
  • Fax: 414-332-0422
Mailing address:
  • Phone: 414-332-6262
  • Fax: 414-332-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number30707
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number30707
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: