1831292903 NPI number — MR. LON EDWARD WRIGHT RPH PD

Table of content: MR. LON EDWARD WRIGHT RPH PD (NPI 1831292903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831292903 NPI number — MR. LON EDWARD WRIGHT RPH PD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
LON
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH PD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831292903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 408
Provider Second Line Business Mailing Address:
13532 HWY 96 E
Provider Business Mailing Address City Name:
MILLPORT
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-662-3817
Provider Business Mailing Address Fax Number:
205-662-5786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13532 HWY 96 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLPORT
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-662-3817
Provider Business Practice Location Address Fax Number:
205-662-5786
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  7060 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000001410 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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