Individual
DR. MARK ALAN WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2310 PEGER RD, STE 105, FAIRBANKS, AK 99709-5315
(907) 479-2663
(907) 479-2691
Mailing address
2310 PEGER RD, STE 105, FAIRBANKS, AK 99709-5315
(907) 479-2663
(907) 479-2691
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
4018
AK
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
4018
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194028200
DEPT OF LABOR ID
AK
05
—
MD07391
—
AK
05
—
MD07392
—
AK
05
—
MD6149
—
AK
Enumeration date
04/26/2006
Last updated
04/18/2013
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