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NPI Code Detail

MEDICARE: WADE G BENNETT PA

MEDICARE: WADE G BENNETT PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantCA13524CA
2363A00000XPhysician Assistant2990CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2021056OTHERCOKAISER COMMERCIAL NUMBER

General Provider Information

NPI Number : 1639128192
Entity Type Code : Individual
Provider Name (Legal Business Name) : WADE G BENNETT PA
Provider Business Mailing Address
First Line : 9285 HEPBURN ST
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80129-2262
Country : US
Telephone Number : 303-338-4545
Fax Number :
Provider Business Practice Location Address
First Line : 9285 HEPBURN ST
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80129-2262
Country : US
Telephone Number : 303-338-4545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 02/25/2011

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Directions to “ WADE G BENNETT PA” Practice Location

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