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NPI Code Detail

MEDICARE: EDWARD DEAN WRIGHT JR.

MEDICARE: EDWARD DEAN WRIGHT JR.
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1982389847
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD DEAN WRIGHT JR.
Provider Business Mailing Address
First Line : 561 BRECKENRIDGE ST APT 202
Second Line :
City : LEXINGTON
State : KY
Zip : 40508-2256
Country : US
Telephone Number : 606-622-4513
Fax Number :
Provider Business Practice Location Address
First Line : 561 BRECKENRIDGE ST APT 202
Second Line :
City : LEXINGTON
State : KY
Zip : 40508-2256
Country : US
Telephone Number : 606-622-4513
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2023
Last Update Date : 06/19/2023

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