Provider Demographics
NPI:1164689287
Name:WAKEFIELD, SARAH MALLARD (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MALLARD
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST STOP 8103
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-8103
Mailing Address - Country:US
Mailing Address - Phone:806-743-2800
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST STOP 8104
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-8352
Practice Address - Country:US
Practice Address - Phone:806-743-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ03832084F0202X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11765Medicaid