Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | L3194 | TX |
NPI | 1134113699 |
---|---|
Provider Name | Robert T Wright |
First Address | Norman, OK 73070-5357 |
Second Address | Harlingen, TX 78550-8307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151701302 | (05) | TX |
H13587 | (02) |