Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 1059 | AL |
Y | 111NS0005X | Chiropractic Sports Physician | 1059 | AL |
NPI | 1194724989 |
---|---|
Provider Name | Dr. David Edward Wade |
First Address | Anniston, AL 36202-1794 |
Second Address | Oxford, AL 36203-2434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 04/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6213099743 | FMCSA (01) | |
T68610 | (02) | AL |