Provider Demographics
NPI:1053335802
Name:WRIGHT, RANDOLPH TERRY (DPM)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:TERRY
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S SHORE CTR W STE 103E
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5762
Mailing Address - Country:US
Mailing Address - Phone:510-521-0441
Mailing Address - Fax:510-521-7473
Practice Address - Street 1:501 S SHORE CTR W STE 103E
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5762
Practice Address - Country:US
Practice Address - Phone:510-521-0441
Practice Address - Fax:510-521-7473
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE23220213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E23220Medicaid
T11286Medicare UPIN
CA000E23220Medicare ID - Type Unspecified