MEDICARE: THOMAS 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
1	207R00000X	Internal Medicine Physician	01049991	IN
2	207R00000X	Internal Medicine Physician	ME 104703	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1619911138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS WADE M.D.

Provider Business Mailing Address
First Line	:	1309 S FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2040
Country	:	US
Telephone Number	:	954-463-4383
Fax Number	:	954-463-8174

Provider Business Practice Location Address
First Line	:	1309 S FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2040
Country	:	US
Telephone Number	:	954-463-4383
Fax Number	:	954-463-8174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	12/14/2009

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