Provider Demographics
NPI:1174562227
Name:WRIGHT, KEITH A (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7588
Mailing Address - Country:US
Mailing Address - Phone:785-587-4101
Mailing Address - Fax:785-587-9090
Practice Address - Street 1:4101 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7588
Practice Address - Country:US
Practice Address - Phone:785-587-4101
Practice Address - Fax:785-587-9090
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423650207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100126090BMedicaid
KS055670WRMedicare ID - Type Unspecified
KS100126090BMedicaid