Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | N1230 | TX |
NPI | 1710907969 |
---|---|
Provider Name | Tracey B Wright |
First Address | Dallas, TX 75390-7201 |
Second Address | Dallas, TX 75235-7701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 03/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0035343 | (05) | NJ |
101032398 | (05) | PA |
I08247 | (02) |