Individual
MR. KENNETH ALAN WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A
Contact information
Practice address
1325 N 600 E, SUITE 102, LOGAN, UT 84341-6738
(435) 753-9999
(435) 753-2301
Mailing address
1325 N 600 E, SUITE 102, LOGAN, UT 84341-6738
(435) 753-9999
(435) 753-2301
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1015921206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1015921206
STATE LICENSE
UT
Enumeration date
01/12/2007
Last updated
11/29/2016
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