Provider Demographics
NPI:1154397842
Name:WRIGHT, GLORIA S (DO)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:S
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 E FM 1518 N
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1360
Mailing Address - Country:US
Mailing Address - Phone:210-654-9300
Mailing Address - Fax:210-654-9302
Practice Address - Street 1:5016 FM 1518
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1360
Practice Address - Country:US
Practice Address - Phone:210-654-9300
Practice Address - Fax:210-654-9302
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W4240OtherBCBS PIN
K4613OtherLICENSE NUMBER
TX8F5227Medicare PIN