Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 23172 | AL |
NPI | 1013961879 |
---|---|
Provider Name | Brian Kenneth Wade |
First Address | Homewood, AL 35209-5603 |
Second Address | Homewood, AL 35209-5603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 24/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0366100001 | CIGNA GOVERNMENT SERVICES PTAN (01) | AL |
133484 | (05) | AL |
511-18907 | BLUE CROSS AND BLUE SHIELD OF ALABAMA (01) | AL |
511-20057 | BLUE CROSS AND BLUE SHIELD OF ALABAMA (01) | AL |