=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922126382
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLORIA S. WRIGHT, D.O., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 08/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17460 IH 35 N #420
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-1264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-654-9300
-----------------------------------------------------
Fax | 210-654-9302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17460 IH 35 N #420
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-1264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-654-9300
-----------------------------------------------------
Fax | 210-654-9302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GLORIA SELVA WRIGHT
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 210-654-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | K4613
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------