=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720310105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID CRAIG WRIGHT, M.D.,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2010
-----------------------------------------------------
Last Update Date | 08/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 LIGHTHOUSE AVE STE 6
-----------------------------------------------------
City | PACIFIC GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-717-4444
-----------------------------------------------------
Fax | 831-717-4446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 LIGHTHOUSE AVE STE 6
-----------------------------------------------------
City | PACIFIC GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93950-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-717-4444
-----------------------------------------------------
Fax | 831-717-4446
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PHYSICIAN
-----------------------------------------------------
Name | DR. DAVID CRAIG WRIGHT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 831-236-8883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | G88577
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------