Provider Demographics
NPI:1164495917
Name:MCBRIDE, WADE J (PA)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:J
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1390 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4430
Mailing Address - Country:US
Mailing Address - Phone:928-344-4325
Mailing Address - Fax:928-344-3084
Practice Address - Street 1:1390 W 16TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4430
Practice Address - Country:US
Practice Address - Phone:928-344-4325
Practice Address - Fax:928-344-3084
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2395363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ542276Medicaid
P39783Medicare UPIN
AZP00275866Medicare UPIN
AZZ107629Medicare PIN
AZ542276Medicaid