Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | DR.0053875 | CO |
N | 208000000X | Pediatrician | DR.0053875 | CO |
NPI | 1205151123 |
---|---|
Provider Name | Dr. Jordan M Wright |
First Address | Denver, CO 80247-1314 |
Second Address | Centennial, CO 80122-2312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2010 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027834 | KAISER COMMERCIAL NUMBER (01) | CO |
22332073 | (05) | CO |