Provider Demographics
NPI:1073668091
Name:WHITMER, WADE W (MD)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:W
Last Name:WHITMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3201 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 175
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3475
Mailing Address - Country:US
Mailing Address - Phone:979-704-6420
Mailing Address - Fax:979-704-6592
Practice Address - Street 1:3201 UNIVERSITY DR E
Practice Address - Street 2:STE 175
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3475
Practice Address - Country:US
Practice Address - Phone:979-704-6420
Practice Address - Fax:979-704-6592
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5768207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097275405Medicaid
TXB27544Medicare UPIN
TX097275405Medicaid