=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811818362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WRIGHT DERMATOLOGY AND MOHS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2026
-----------------------------------------------------
Last Update Date | 07/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 E. 4TH STREET
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-570-9111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 E. 4TH STREET PO BOX 85638
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-570-9111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PHYSICIAN
-----------------------------------------------------
Name | KEVIN T. WRIGHT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 707-570-9111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------