Provider Demographics
NPI:1043490881
Name:PATRICIA TANYA WADE MD, LLC
Entity Type:Organization
Organization Name:PATRICIA TANYA WADE MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE-GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-965-1119
Mailing Address - Street 1:PO BOX 823902
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33082
Mailing Address - Country:US
Mailing Address - Phone:954-965-1119
Mailing Address - Fax:954-965-0119
Practice Address - Street 1:2301 N UNIVERSITY DR
Practice Address - Street 2:SUITE 207
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3617
Practice Address - Country:US
Practice Address - Phone:954-965-1119
Practice Address - Fax:954-965-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI478Medicare PIN