Individual
KELVIN C WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 HALL ST STE A, MONROE, LA 71201-7528
(318) 324-9113
(318) 329-9382
Mailing address
401 HALL ST STE A, MONROE, LA 71201-7528
(318) 324-9113
(318) 329-9382
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11502R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1664782
—
LA
Enumeration date
03/16/2007
Last updated
07/02/2010
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