Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 58-002731 | OH |
NPI | 1144468711 |
---|---|
Provider Name | Dr. Daniel E Wade JR. |
First Address | Ontario, OH 44906-1705 |
Second Address | Cuyahoga Falls, OH 44223-1404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2009 |
Last Update Date | 13/09/2021 |