Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0423650 | KS |
N | 207QS0010X | Family Doctor - Sports Medicine | 0423650 | KS |
NPI | 1174562227 |
---|---|
Provider Name | Dr. Keith A Wright |
First Address | Manhattan, KS 66503-7588 |
Second Address | Manhattan, KS 66503-7588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 25/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100126090B | (05) | KS |
A13205 | (02) | KS |