MEDICARE: RANDALL WILLIAM WADE M.D.

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
1	207QA0505X	Adult Medicine Physician	G7117	TX

General Provider Information

NPI Number	:	1881782373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL WILLIAM WADE M.D.

Provider Business Mailing Address
First Line	:	120 SOUTH CENTRAL EXPRESSWAY
Second Line	:	SUITE 124
City	:	MCKINNEY
State	:	TX
Zip	:	75070-3753
Country	:	US
Telephone Number	:	972-548-5388
Fax Number	:	972-548-7318

Provider Business Practice Location Address
First Line	:	120 S CENTRAL EXPY
Second Line	:	SUITE 124
City	:	MCKINNEY
State	:	TX
Zip	:	75070-3742
Country	:	US
Telephone Number	:	972-548-5388
Fax Number	:	972-548-7318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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