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General NPI Number Information
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NPI Number | 1558711689
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Entity Type | Individual
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Provider Name | KADIJO WADE-THOMAS MD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 1833 BOULEVARD
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City | JACKSONVILLE
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State | FL
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Zip | 32206-4382
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Country | US
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Telephone | 904-383-1040
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Fax |
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Provider Business Mailing Address
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Address Line | 1833 BOULEVARD POB 5TH FLOOR
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City | JACKSONVILLE
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State | FL
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Zip | 32206
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Country | US
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Telephone | 904-244-0350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TRN 23166
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME138582
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License Number State | FL
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