Basic Information
Provider Information
NPI: 1003806100
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WRIGHT
FirstName: DOUGLAS
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 WATER ST
Address2: STE E200
City: KERRVILLE
State: TX
PostalCode: 780283523
CountryCode: US
TelephoneNumber: 8302576633
FaxNumber: 8302576620
Practice Location
Address1: 1001 WATER ST
Address2: SUITE E200
City: KERRVILLE
State: TX
PostalCode: 780285329
CountryCode: US
TelephoneNumber: 8302576633
FaxNumber: 8302576620
Other Information
ProviderEnumerationDate: 10/28/2005
LastUpdateDate: 10/05/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XH2914TXY Other Service ProvidersSpecialist 

ID Information
IDTypeStateIssuerDescription
1395279-1505TX MEDICAID
74261510801TXTAX IDOTHER
106834401TXDEAOTHER


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