Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01046850A | IN |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 01046850A | IN |
NPI | 1225039753 |
---|---|
Provider Name | Stephen A Wright |
First Address | Fort Wayne, IN 46825-5822 |
Second Address | Fort Wayne, IN 46825-5886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 22/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
058940Z | MEDICARE PTAN (01) | IN |
200026087 | RAIL ROAD MEDICARE (01) | IN |
200142130 | (05) | IN |
2030457 | (05) | OH |
F02163 | (02) | IN |