Provider Demographics
NPI:1992745913
Name:WRIGHT, JOHN MALCOM (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MALCOM
Last Name:WRIGHT
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 1:3219 CENTRAL AVE
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2949
Mailing Address - Country:US
Mailing Address - Phone:308-865-2600
Mailing Address - Fax:308-865-2990
Practice Address - Street 1:3219 CENTRAL AVE
Practice Address - Street 2:SUITE 102A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2949
Practice Address - Country:US
Practice Address - Phone:308-865-2600
Practice Address - Fax:308-865-2990
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22031207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200254920AMedicaid
NE236422OtherMIDLANDS CHOICE
NE35949OtherBCBS OF NEBRASKA
KS200254920AMedicaid
NE236422OtherMIDLANDS CHOICE
G84927Medicare UPIN
NE200043703Medicare ID - Type UnspecifiedRR MEDICARE
NENA1892011Medicare PIN