MEDICARE: MR. JEFFREY J WRIGHT PA-C

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	363AM0700X	Medical Physician Assistant	363	WV

General Provider Information

NPI Number	:	1235209321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY J WRIGHT PA-C

Provider Business Mailing Address
First Line	:	4914 ELK RIVER RD STE A
Second Line	:
City	:	ELKVIEW
State	:	WV
Zip	:	25071-9278
Country	:	US
Telephone Number	:	304-965-7051
Fax Number	:	304-965-5074

Provider Business Practice Location Address
First Line	:	4914 ELK RIVER RD STE A
Second Line	:
City	:	ELKVIEW
State	:	WV
Zip	:	25071-9278
Country	:	US
Telephone Number	:	304-965-7051
Fax Number	:	304-965-5074

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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