Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0190192233 | IL |
NPI | 1043228398 |
---|---|
Provider Name | Dr. Bradley C Wright |
First Address | Hutchinson, KS 67502-1133 |
Second Address | Hutchinson, KS 67502-1133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 25/04/2011 |