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General NPI Number Information
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NPI Number | 1669429049
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Entity Type | Individual
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Provider Name | WADE M CEOLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 1906 BLAKE AVE
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City | GLENWOOD SPGS
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State | CO
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Zip | 81601-4227
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Country | US
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Telephone | 970-384-6770
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Fax | 970-384-6610
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Provider Business Mailing Address
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Address Line | 1906 BLAKE AVE
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City | GLENWOOD SPGS
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State | CO
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Zip | 81601-4227
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Country | US
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Telephone | 970-384-6770
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Fax | 970-384-6610
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 2001013105
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | E1615
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 53071
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License Number State | CO
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