Provider Demographics
NPI:1447273107
Name:WRIGHT, LONNIE BENTON (MD)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:BENTON
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 1:310 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-9847
Mailing Address - Country:US
Mailing Address - Phone:501-520-7782
Mailing Address - Fax:
Practice Address - Street 1:310 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-9847
Practice Address - Country:US
Practice Address - Phone:501-520-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-27862085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142011001Medicaid
ARE2786OtherLICENSE
H26262Medicare UPIN