Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 5901001133 | MI |
NPI | 1396724027 |
---|---|
Provider Name | Dr. Rod Wright |
First Address | Tawas City, MI 48763-9251 |
Second Address | Tawas City, MI 48763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 24/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
383429223 48763 A001 | WPS TRI CARE FOR LIFE (01) | MI |
4310389 | (05) | MI |
480026004 | PALMETTO GBA-R'ROAD M'CAR (01) | MI |
71020000C51005 | BLUE CROSS BLUE SHIELD (01) | MI |
T34277 | (02) |