MEDICARE: CLIFTON WRIGHT

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	247100000X	Radiologic Technologist	R33794	TX

General Provider Information

NPI Number	:	1407226129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFTON WRIGHT

Provider Business Mailing Address
First Line	:	2201 MAIN ST
Second Line	:	STE1299
City	:	DALLAS
State	:	TX
Zip	:	75201-4327
Country	:	US
Telephone Number	:	214-760-1661
Fax Number	:	214-760-1667

Provider Business Practice Location Address
First Line	:	2201 MAIN ST
Second Line	:	STE1299
City	:	DALLAS
State	:	TX
Zip	:	75201-4327
Country	:	US
Telephone Number	:	214-760-1661
Fax Number	:	214-760-1667

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

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	10/07/2015

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Directions to “ CLIFTON WRIGHT ” Practice Location

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