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NPI Code Detail

MEDICARE: LARRY ALLEN WADE M.D.

MEDICARE: LARRY ALLEN WADE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician34545CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245230317
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY ALLEN WADE M.D.
Provider Business Mailing Address
First Line : 4141 E DICKENSON PL
Second Line :
City : DENVER
State : CO
Zip : 80222-6012
Country : US
Telephone Number : 303-504-6509
Fax Number : 303-782-0916
Provider Business Practice Location Address
First Line : 4141 E DICKENSON PL
Second Line :
City : DENVER
State : CO
Zip : 80222-6012
Country : US
Telephone Number : 303-504-6509
Fax Number : 303-782-0916
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 07/08/2007

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