MEDICARE: COREY DOUGLAS WRIGHT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1985	OK
2	363AS0400X	Surgical Physician Assistant	PA.0004584	CO

General Provider Information

NPI Number	:	1023311263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY DOUGLAS WRIGHT PA

Provider Business Mailing Address
First Line	:	PO BOX 110429
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80042-0429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12505 E 16TH AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80045-0000
Country	:	US
Telephone Number	:	303-724-2728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	06/03/2025

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