Provider Demographics
NPI:1235235094
Name:DAVID G WADE DPM
Entity Type:Organization
Organization Name:DAVID G WADE DPM
Other - Org Name:PODIATRIC ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-329-8545
Mailing Address - Street 1:PO BOX 1998
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-1998
Mailing Address - Country:US
Mailing Address - Phone:405-943-6200
Mailing Address - Fax:
Practice Address - Street 1:5401 N PORTLAND AVE STE 390
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2082
Practice Address - Country:US
Practice Address - Phone:405-943-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK120213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty