Provider Information for 1326433343
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Mr. JAMES NOLAN WADE II
Sex: Male
NPI: 1326433343
Last Updated: 2022-08-05
Certification Date: 2022-08-05
Certification Date: 2022-08-05
Details
| Name | Value | ||||||||||||
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| NPI | 1326433343 | ||||||||||||
| Enumeration Date | 2015-04-06 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1180 OLD JACKSON RD FARMINGTON, MO 63640-3428 United States Phone: 314-435-6198 | Fax: | ||||||||||||
| Primary Practice Address | 1180 OLD JACKSON RD FARMINGTON, MO 63640 United States Phone: 314-435-6198 | Fax: | ||||||||||||
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