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General NPI Number Information
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NPI Number | 1174657332
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASES ASSOCIATES OF NORTHWEST FLORIDA PA
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 5153 N 9TH AVE SUITE 305
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City | PENSACOLA
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State | FL
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Zip | 32504-5719
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Country | US
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Telephone | 850-476-3131
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Fax | 850-476-4848
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Provider Business Mailing Address
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Address Line | 5153 N 9TH AVE SUITE 305
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City | PENSACOLA
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State | FL
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Zip | 32504-5719
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Country | US
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Telephone | 850-476-3131
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Fax | 850-476-4848
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. BARBARA H WADE
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Credential | M.D.
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Telephone | 850-476-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 601606
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License Number State | FL
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