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General NPI Number Information
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NPI Number | 1437508900
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Entity Type | Individual
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Provider Name | DALLAS GLEN WRIGHT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 6901 MEDICAL PKWY
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City | WACO
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State | TX
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Zip | 76712
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Country | US
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Telephone | 254-751-4242
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Fax | 254-751-4243
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Provider Business Mailing Address
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Address Line | 3105 SKINNER DR
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City | LORENA
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State | TX
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Zip | 76655-3239
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Country | US
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Telephone | 804-358-7488
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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 | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | S3092
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | BP1OO57711
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License Number State | TX
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