Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | WV10321 | WV |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | WV10321 | WV |
NPI | 1215066873 |
---|---|
Provider Name | Dr. John A Wade JR. |
First Address | Point Pleasant, WV 25550-1528 |
Second Address | Point Pleasant, WV 25550-1528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 24/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001719894 | BLUE CROSS BLUE SHIELD (01) | WV |
0101405000 | (05) | WV |
0363655 | (05) | OH |
A71996 | (02) | WV |