Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 22427 | WV |
N | 207RP1001X | Pulmonary Disease | 22427 | WV |
NPI | 1003029075 |
---|---|
Provider Name | Dr. William Alexander Wade |
First Address | South Charleston, WV 25309 |
Second Address | South Charleston, WV 25309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 05/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810017670 | (05) | WV |