Healthcare Provider Details

I. General information

NPI: 1093729113
Provider Name (Legal Business Name): ANDREW JACOB WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 2ND ST
RICHLAND CENTER WI
53581-1900
US

IV. Provider business mailing address

301 E 2ND ST
RICHLAND CENTER WI
53581-1900
US

V. Phone/Fax

Practice location:
  • Phone: 608-647-6161
  • Fax: 608-647-3178
Mailing address:
  • Phone: 608-647-6161
  • Fax: 608-647-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50716
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: