Provider Demographics
NPI:1285705228
Name:WRIGHT, LUTHER L JR (MD,MSC,MT(ASCP))
Entity type:Individual
Prefix:DR
First Name:LUTHER
Middle Name:L
Last Name:WRIGHT
Suffix:JR
Gender:M
Credentials:MD,MSC,MT(ASCP)
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Mailing Address - Street 1:524 SOUTHPARK BOULEVARD
Mailing Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:804-504-7980
Mailing Address - Fax:804-504-7991
Practice Address - Street 1:524 SOUTHPARK BOULEVARD
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-504-7980
Practice Address - Fax:804-504-7991
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-10-07
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Provider Licenses
StateLicense IDTaxonomies
VA0101241279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285705228Medicaid
VA293417OtherBCBS
VAP00435807Medicare PIN
VA1285705228Medicaid