Individual
DAVID A WADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 N MEDICAL DR # E13, SALT LAKE CITY, UT 84132-0001
(801) 581-2955
Mailing address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 587-6340
(801) 587-6346
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
50181
MN
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
5558245-1205
UT
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
5558245-1205
UT
207ZP0104X
Chemical Pathology Physician
5558245-1205
UT
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
103224
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
440937100
—
MN
01
—
P00839042
MEDICARE, RAILROAD
MN
Enumeration date
05/29/2007
Last updated
05/26/2023
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