Individual
WADE C MYERS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-5488
(401) 444-7865
Mailing address
593 EDDY ST, APC 978, PROVIDENCE, RI 02903-4923
(401) 444-4318
(401) 444-7865
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
MD13110
RI
2084P0800X
Psychiatry Physician
Primary
MD13110
RI
2084P0804X
Child & Adolescent Psychiatry Physician
MD13110
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049176400
—
FL
01
—
68471
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/17/2006
Last updated
09/09/2009
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