Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 33358 | NE |
NPI | 1033675046 |
---|---|
Provider Name | Dr. Timothy William Wright |
First Address | Joint Base Lewis Mcchord, WA 98431-1000 |
Second Address | Joint Base Lewis Mcchord, WA 98431-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2019 |
Last Update Date | 30/09/2021 |