Individual
WADE G DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1401 CENTERVILLE ROAD, SUITE 100, TALLAHASSEE, FL 32308-3656
(850) 877-5183
(850) 656-1288
Mailing address
1401 CENTERVILLE ROAD, SUITE 100, TALLAHASSEE, FL 32308-3656
(850) 877-5183
(850) 656-1288
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
21963
WV
208600000X
Surgery Physician
Primary
ME120744
FL
2086X0206X
Surgical Oncology Physician
21963
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2586732
—
OH
05
—
3810002707
—
WV
05
—
64102411
—
KY
Enumeration date
03/25/2006
Last updated
08/19/2014
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