Individual
WADE CLARK VAN SICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 9TH ST, FLORENCE, OR 97439-7388
(541) 997-7104
(541) 997-5975
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
122314
FL
207X00000X
Orthopaedic Surgery Physician
75050
MN
207X00000X
Orthopaedic Surgery Physician
MD.202524
LA
207X00000X
Orthopaedic Surgery Physician
Primary
MD222569
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1500356
—
LA
Enumeration date
04/08/2008
Last updated
01/21/2025
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