Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 21446 | MS |
NPI | 1255527743 |
---|---|
Provider Name | Dr. Patrick Beaumont Wright |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2007 |
Last Update Date | 31/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03331213 | (05) | MS |
131324 | (05) | AL |
155209 | (05) | AL |
2407210 | (05) | LA |