Healthcare Provider Details

I. General information

NPI: 1891855615
Provider Name (Legal Business Name): WADE F EXUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E TULARE AVE
VISALIA CA
93292-3629
US

IV. Provider business mailing address

3500 W OLIVE AVE SUITE 300
BURBANK CA
91505-4628
US

V. Phone/Fax

Practice location:
  • Phone: 559-732-8086
  • Fax:
Mailing address:
  • Phone: 702-497-8202
  • Fax: 213-403-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC40240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: