Individual
DR. GORDON FREDERICK WADGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 OCHSNER BLVD STE 460, GRETNA, LA 70056-5282
(504) 371-9355
Mailing address
1514 JEFFERSON HIGHWAY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MD.208087
LA
208M00000X
Hospitalist Physician
MD.208087
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06588588
—
MS
05
—
2196537
—
LA
Enumeration date
03/20/2012
Last updated
07/31/2019
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