Individual
STANLEY A. WADE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-9223
(601) 703-9405
Mailing address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-4282
(601) 703-4597
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
06967
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115344
—
MS
01
—
730-12551
BLUE CROSS OF AL
—
01
—
P00069795
RAILROAD MEDICARE
—
Enumeration date
11/20/2005
Last updated
11/08/2013
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