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General NPI Number Information
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NPI Number | 1164140786
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Entity Type | Individual
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Provider Name | ALEX STEPHEN WRIGHT PA
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Gender | Male
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 205 N BERKLEY ST
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City | COUNCIL
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State | ID
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Zip | 83612-5015
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Country | US
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Telephone | 208-253-4242
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Fax | 208-253-6849
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Provider Business Mailing Address
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Address Line | PO BOX 428
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City | COUNCIL
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State | ID
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Zip | 83612-0428
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Country | US
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Telephone | 208-253-4242
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Fax | 208-253-6849
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9361272
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License Number State | ID
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