Provider Demographics
NPI:1063436285
Name:ALBRIGHT, JEROLD D (MD)
Entity type:Individual
Prefix:
First Name:JEROLD
Middle Name:D
Last Name:ALBRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N LORRAINE ST
Mailing Address - Street 2:STE 110
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501
Mailing Address - Country:US
Mailing Address - Phone:620-663-8484
Mailing Address - Fax:620-663-9526
Practice Address - Street 1:1600 N LORRAINE ST
Practice Address - Street 2:STE 110
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501
Practice Address - Country:US
Practice Address - Phone:620-663-8484
Practice Address - Fax:620-663-9526
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0413725207X00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100125460CMedicaid
KS105298OtherBCBS PROVIDER NO.
KS100125460CMedicaid
KSB68164Medicare UPIN