Provider Demographics
NPI:1205041944
Name:ROBIRTS, WADE LOUIS (DT DO)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:LOUIS
Last Name:ROBIRTS
Suffix:
Gender:M
Credentials:DT DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NE SAVANNAH DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4873
Mailing Address - Country:US
Mailing Address - Phone:541-318-7266
Mailing Address - Fax:541-318-4629
Practice Address - Street 1:600 NE SAVANNAH DR STE 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4873
Practice Address - Country:US
Practice Address - Phone:541-318-7266
Practice Address - Fax:541-318-4629
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT DO 873997246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR129200Medicaid