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General NPI Number Information
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NPI Number | 1952455370
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Entity Type | Individual
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Provider Name | JOHNNY C WRIGHT M.D., D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 340 BROAD ST SUITE 100
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City | WINDSOR
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State | CT
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Zip | 06095-3030
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Country | US
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Telephone | 860-580-7170
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Fax | 860-580-7177
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Provider Business Mailing Address
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Address Line | 340 BROAD ST STE 100
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City | WINDSOR
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State | CT
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Zip | 06095-3030
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Country | US
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Telephone | 413-505-4888
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 049981
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 80178
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License Number State | MS
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