Individual
MR. WADE BITTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
1102 W MACARTHUR ST, SHAWNEE, OK 74804-1743
(405) 273-2270
Mailing address
1102 W MACARTHUR ST, SHAWNEE, OK 74804-1743
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1681
OK
363A00000X
Physician Assistant
1681
OK
363A00000X
Physician Assistant
Primary
PA1681
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200135230A
—
OK
Enumeration date
01/23/2008
Last updated
01/12/2009
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