Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 26924 | AL |
NPI | 1033167465 |
---|---|
Provider Name | Dr. Merle Lindy Wade JR. |
First Address | Gadsden, AL 35903-1156 |
Second Address | Gadsden, AL 35903-1156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 16/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009937819 | (05) | AL |
C100 | CLINIC ID-GADSDEN (01) | AL |
C243 | CLINIC ID-BOAZ (01) | AL |
C373 | CLINIC ID-FT PAYNE (01) | AL |