Provider Demographics
NPI:1194918201
Name:ROY R WRIGHT M D LLC
Entity type:Organization
Organization Name:ROY R WRIGHT M D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-781-7140
Mailing Address - Street 1:850 E HARVARD AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210
Mailing Address - Country:US
Mailing Address - Phone:303-781-7140
Mailing Address - Fax:303-761-2536
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:225
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5073
Practice Address - Country:US
Practice Address - Phone:303-781-7140
Practice Address - Fax:303-761-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15974251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC97871Medicare UPIN