Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | J0266 | TX |
Y | 208D00000X | General Practice Physician | J0266 | TX |
NPI | 1205950953 |
---|---|
Provider Name | Dr. Wright Wiley Singleton |
First Address | Hurst, TX 76053-7375 |
Second Address | Hurst, TX 76053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 22/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E96710 | (02) |