Individual
DR. SCOTT ALAN WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
802 N RIVERSIDE RD STE G50, SAINT JOSEPH, MO 64507-2510
(816) 671-4888
(816) 671-4890
Mailing address
802 N RIVERSIDE RD STE G50, SAINT JOSEPH, MO 64507-2510
(816) 671-4888
(816) 671-4890
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
100462
MO
2086S0127X
Trauma Surgery Physician
100462
MO
2086S0129X
Vascular Surgery Physician
100462
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001185602
COMMUNITY HEALTH PLAN
MO
05
—
100132200B
—
KS
05
—
203325600
—
MO
01
—
P00203415
RR MEDICARE
MO
Enumeration date
07/10/2006
Last updated
12/01/2017
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