Provider Demographics
NPI:1174781231
Name:LAUTEN, WRIGHT B (MD)
Entity type:Individual
Prefix:DR
First Name:WRIGHT
Middle Name:B
Last Name:LAUTEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:109 MILLSAPS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1587
Mailing Address - Country:US
Mailing Address - Phone:601-255-0736
Mailing Address - Fax:601-255-0735
Practice Address - Street 1:109 MILLSAPS DR
Practice Address - Street 2:SUITE B
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1587
Practice Address - Country:US
Practice Address - Phone:601-255-0736
Practice Address - Fax:601-255-0735
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME109594207W00000X
MS21600207W00000X, 207WX0107X
AL29277207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL108970Medicaid
AL51597161OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
MS07831241Medicaid
MS302I180506Medicare PIN
AL51597161OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA