Provider Demographics
NPI:1114967775
Name:WADE, JEFFREY DARRELL (M D)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DARRELL
Last Name:WADE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PKWY STE 510
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3509
Mailing Address - Country:US
Mailing Address - Phone:205-971-1750
Mailing Address - Fax:
Practice Address - Street 1:3686 GRANDVIEW PKWY STE 510
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3509
Practice Address - Country:US
Practice Address - Phone:205-971-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.15806207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-76189Medicare ID - Type Unspecified
ALF08396Medicare UPIN