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NPI Code Detail

MEDICARE: DR. WILLIAM E WADE III DO

MEDICARE: DR. WILLIAM E WADE III DO
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
1207Q00000XFamily Medicine PhysicianR-8A01MO

General Provider Information

NPI Number : 1861623944
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM E WADE III DO
Provider Business Mailing Address
First Line : PO BOX 140067
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63114-0067
Country : US
Telephone Number : 314-258-2520
Fax Number : 314-427-2577
Provider Business Practice Location Address
First Line : 12 W SHERWOOD DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63114-5715
Country : US
Telephone Number : 314-258-2520
Fax Number : 314-427-2577
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2009
Last Update Date : 08/06/2009

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