Provider Demographics
NPI:1194257139
Name:AUMILLER, WADE (PHD PA-C)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:AUMILLER
Suffix:
Gender:M
Credentials:PHD PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N WALDROP DR STE 403
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4703
Mailing Address - Country:US
Mailing Address - Phone:817-701-4253
Mailing Address - Fax:
Practice Address - Street 1:1001 N WALDROP DR STE 403
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4703
Practice Address - Country:US
Practice Address - Phone:817-701-4253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
363AS0400XOtherTAXONOMY CODE