Provider Demographics
NPI:1699776484
Name:WADE, PAUL D (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 N CENTRAL EXPY STE 300B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5945
Mailing Address - Country:US
Mailing Address - Phone:469-800-7100
Mailing Address - Fax:214-363-2608
Practice Address - Street 1:9101 N CENTRAL EXPY STE 300B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5945
Practice Address - Country:US
Practice Address - Phone:469-800-7100
Practice Address - Fax:214-363-2608
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-12-03
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXF5086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098668904Medicaid
TX8S0456OtherBCBS
TX098668903Medicaid
TX098668905Medicaid
TX8J2071Medicare PIN
TX098668904Medicaid
TX8F20905Medicare PIN
TX8S0456OtherBCBS
TXP01090798Medicare PIN