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Individual

DR. VINCE T WAKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4760 BELPAR ST NW, CANTON, OH 44718-3603
(330) 492-9200
(330) 492-5454
Mailing address
4760 BELPAR ST NW, CANTON, OH 44718-3603
(330) 492-9200
(330) 492-5454

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
35089257
OH
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
35089257
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2890028
OH
Enumeration date
03/08/2007
Last updated
04/05/2011
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