Individual
DAVID C WADE
Active
Individual
DAVID C WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY D
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1081
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115025
MANAGED HEALTH NETWORK
OR
01
—
400707
VALUE OPTIONS
OR
01
—
885235000
REGENCE BCBSO
OR
01
—
YC73001
PACIFIC SOURCE
OR
Enumeration date
02/15/2007
Last updated
05/22/2018
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