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General NPI Number Information
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NPI Number | 1053712737
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Entity Type | Organization
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Legal Business Name | DAVID G. WADE DPM PLLC
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 3330 NW 56TH ST #600
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4479
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Country | US
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Telephone | 405-947-8041
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 269092
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-9092
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID WADE
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Credential | MD
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Telephone | 405-488-7677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 120
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License Number State | OK
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