Provider Demographics
NPI:1679372320
Name:WRIGHT, ISAAC JR
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:
Last Name:WRIGHT
Suffix:JR
Gender:
Credentials:
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 173455
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33017-3455
Mailing Address - Country:US
Mailing Address - Phone:646-320-0834
Mailing Address - Fax:
Practice Address - Street 1:725 REGINA LN
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-2747
Practice Address - Country:US
Practice Address - Phone:646-320-0834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW623-400-61-297-0172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver