Provider Demographics
NPI:1285134759
Name:WADE, JASON ALAN
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ALAN
Last Name:WADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16635 SPRING CYPRESS RD # 917
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1713
Mailing Address - Country:US
Mailing Address - Phone:713-853-9299
Mailing Address - Fax:
Practice Address - Street 1:8722 AUBURN GLEN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-4698
Practice Address - Country:US
Practice Address - Phone:713-853-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment