Provider Demographics
NPI:1699937417
Name:GARY L WRIGHT MD INC
Entity type:Organization
Organization Name:GARY L WRIGHT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LAMON
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-532-3821
Mailing Address - Street 1:664 PAULINE CT # G
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5210
Mailing Address - Country:US
Mailing Address - Phone:209-532-3821
Mailing Address - Fax:209-532-0164
Practice Address - Street 1:664 PAULINE CT
Practice Address - Street 2:G
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5210
Practice Address - Country:US
Practice Address - Phone:209-532-3821
Practice Address - Fax:209-532-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39395207N00000X, 207NS0135X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA165AMedicare PIN