Provider Demographics
NPI:1366408650
Name:WRIGHT, TIMOTHY ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROBERT
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:PO BOX 10002
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-0002
Mailing Address - Country:US
Mailing Address - Phone:623-561-7222
Mailing Address - Fax:
Practice Address - Street 1:18701 N 67TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-561-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17772207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3981220OtherEVERCARE GRP
AZAZ0728670OtherBLUE CROSS BLUE SHIELD GR
AZ097990Medicaid
AZAW1436OtherHEALTHNET GRP
E34703Medicare UPIN
AZ097990Medicaid