Healthcare Provider Details

I. General information

NPI: 1164495917
Provider Name (Legal Business Name): WADE J MCBRIDE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W SAINT MARYS RD STE 101
TUCSON AZ
85745-2612
US

IV. Provider business mailing address

PO BOX 18892
BELFAST ME
04915-4083
US

V. Phone/Fax

Practice location:
  • Phone: 520-622-5912
  • Fax:
Mailing address:
  • Phone: 928-344-4325
  • Fax: 928-344-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2395
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: