Basic Information
| Provider Information | |||||||||
| NPI: | 1033552831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | DALLAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 841656 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752841656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035315000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 E DAWSON ST | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757012036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035314262 | ||||||||
| FaxNumber: | 9035315097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2013 | ||||||||
| LastUpdateDate: | 06/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 6923 | OK | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | R1325 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 75-0818167-051 | 01 | TX | TRICARE | OTHER | 8GX945 | 01 | TX | BCBS | OTHER | P01876976 | 01 | TX | MEDICARE RAIL ROAD | OTHER | 75-1976930-005 | 01 | TX | TRICARE | OTHER | 374305601 | 05 | TX | MEDICAID | 374305602 | 05 | TX | MEDICAID | 581283YS6P | 01 | TX | MEDICARE | OTHER | 581283YS6V | 01 | TX | MEDICARE | OTHER | 75-0818167-015 | 01 | TX | TRICARE | OTHER | 75-0818167-044 | 01 | TX | TRICARE | OTHER | 75-0818167-048 | 01 | TX | TRICARE | OTHER | P01877173 | 01 | TX | MEDICARE RAIL ROAD | OTHER |