Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 5007 | TX |
NPI | 1124176284 |
---|---|
Provider Name | Monty C. Wright |
First Address | San Angelo, TX 76903-5923 |
Second Address | San Angelo, TX 76903-5923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 04/06/2012 |