Provider Demographics
NPI:1235143439
Name:WRIGHT, STEPHEN J (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:299 E PENDLETON AVE
Mailing Address - Street 2:P.O. BOX 547
Mailing Address - City:LAPEL
Mailing Address - State:IN
Mailing Address - Zip Code:46051-5546
Mailing Address - Country:US
Mailing Address - Phone:765-534-3636
Mailing Address - Fax:765-534-3638
Practice Address - Street 1:299 E PENDLETON AVE
Practice Address - Street 2:# 547
Practice Address - City:LAPEL
Practice Address - State:IN
Practice Address - Zip Code:46051-5546
Practice Address - Country:US
Practice Address - Phone:765-534-3636
Practice Address - Fax:765-534-3638
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01028188A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000312904OtherANTHEM
IN15D2075563OtherCLIA
IN100171430Medicaid
IN46-4572927OtherTAX ID WFP
INP01309423OtherPALMETO RAILROAD MEDICARE
INE05596Medicare UPIN
IN100171430Medicaid
INM400047878Medicare PIN