Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E23220 | CA |
NPI | 1053335802 |
---|---|
Provider Name | Dr. Randolph Terry Wright |
First Address | Alameda, CA 94501-5762 |
Second Address | Alameda, CA 94501-5762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 07/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E23220 | (05) | CA |
T11286 | (02) |