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General NPI Number Information
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NPI Number | 1336574250
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Entity Type | Individual
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Provider Name | BROOKS EVERETT WRIGHT D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 7391 W CHARLESTON BLVD STE 140
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City | LAS VEGAS
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State | NV
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Zip | 89117-1577
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Country | US
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Telephone | 702-823-4255
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 WINCANTON DR
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City | LAS VEGAS
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State | NV
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Zip | 89134-6172
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Country | US
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Telephone | 407-760-5981
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | DO2205
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License Number State | NV
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