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General NPI Number Information
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NPI Number | 1689634388
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Entity Type | Individual
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Provider Name | WADE G DOUGLAS MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2006
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 1401 CENTERVILLE ROAD SUITE 100
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City | TALLAHASSEE
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State | FL
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Zip | 32308-3656
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Country | US
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Telephone | 850-877-5183
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Fax | 850-656-1288
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Provider Business Mailing Address
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Address Line | 1401 CENTERVILLE ROAD SUITE 100
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City | TALLAHASSEE
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State | FL
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Zip | 32308-3656
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Country | US
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Telephone | 850-877-5183
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Fax | 850-656-1288
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 21963
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME120744
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 21963
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License Number State | WV
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