Organization Name: | RICKEY WRIGHT MD LLC |
NPI Number: | 1215137567 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICKEY WRIGHT (OWNER) |
Mailing Address: | 1823 W State St Fremont |
State: | OH US |
Postal Code: | 434201635 |
Phone Number: | 4193347737 |
Fax Number: | 4193342528 |
NPI Enumeration Date: | 07/24/2007 |
NPI Last Update Date: | 07/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 35058763 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |