MEDICARE: DR. DAVID DORMAN 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	207VG0400X	Gynecology Physician	4301047366	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11292387	OTHER	MI	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538123500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID DORMAN WRIGHT M.D.

Provider Business Mailing Address
First Line	:	3960 W ROYAL DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-9200
Country	:	US
Telephone Number	:	231-947-0404
Fax Number	:	231-947-2190

Provider Business Practice Location Address
First Line	:	3960 W ROYAL DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-9200
Country	:	US
Telephone Number	:	231-947-0404
Fax Number	:	231-947-2190

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	06/28/2010

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