Provider Demographics
NPI:1215025622
Name:WADE, TYRONE CURTIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:TYRONE
Middle Name:CURTIS
Last Name:WADE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4242 SW 22 LN
Mailing Address - Street 2:119
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6726
Mailing Address - Country:US
Mailing Address - Phone:352-379-4998
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0239
Practice Address - Fax:352-338-9879
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN9997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRES000Medicare UPIN