Individual
JASON BRIAN WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10505 DOROTHY DR, OKLAHOMA CITY, OK 73162-6848
(405) 421-8560
Mailing address
10505 DOROTHY DR, OKLAHOMA CITY, OK 73162-6848
(405) 421-8560
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/18/2019
Last updated
09/18/2019
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