Provider Demographics
NPI:1083669600
Name:GADE, GEORGE FREDRIK (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:FREDRIK
Last Name:GADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 SEAWARD RD
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2600
Mailing Address - Country:US
Mailing Address - Phone:509-494-9753
Mailing Address - Fax:
Practice Address - Street 1:1717 N E ST STE 422
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6333
Practice Address - Country:US
Practice Address - Phone:850-469-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60027817207T00000X
CAG32809207T00000X
FLME88858207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery