Provider Demographics
NPI:1417699539
Name:WRIGHT, JERVON A (MD, MPH)
Entity type:Individual
Prefix:
First Name:JERVON
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N FLAMINGO ROAD
Mailing Address - Street 2:GRADUATE MEDICAL EDUCATION, 2ND FLOOR
Mailing Address - City:MANHASSET
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1006
Mailing Address - Country:US
Mailing Address - Phone:954-265-4463
Mailing Address - Fax:
Practice Address - Street 1:703 N FLAMINGO ROAD
Practice Address - Street 2:GRADUATE MEDICAL EDUCATION, 2ND FLOOR
Practice Address - City:MANHASSET
Practice Address - State:FL
Practice Address - Zip Code:11030-3876
Practice Address - Country:US
Practice Address - Phone:954-265-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-09
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLTRN41842207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program