MEDICARE: DR. CHARLES JOHN WRIGHT M.D.

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	207T00000X	Neurological Surgery Physician	G059721	CA
2	207T00000X	Neurological Surgery Physician	036-082040	IL
3	207T00000X	Neurological Surgery Physician	N7599	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1H4413	OTHER	TX	PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427012921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES JOHN WRIGHT M.D.

Provider Business Mailing Address
First Line	:	367 S GULPH RD
Second Line	:	ATTN :IPM CREDENTIALING
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-3121
Country	:	US
Telephone Number	:	484-913-7467
Fax Number	:	610-878-3965

Provider Business Practice Location Address
First Line	:	3501 S SONCY RD STE 104
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79119-6405
Country	:	US
Telephone Number	:	806-398-3627
Fax Number	:	806-351-7801

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	05/07/2021

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Directions to “ DR. CHARLES JOHN WRIGHT M.D.” Practice Location

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