Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | MD.208087 | LA |
NPI | 1043585326 |
---|---|
Provider Name | Dr. Gordon Frederick Wadge |
First Address | New Orleans, LA 70121-2429 |
Second Address | Gretna, LA 70056-5282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 31/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06588588 | (05) | MS |
2196537 | (05) | LA |