Provider Demographics
NPI:1326782970
Name:WADE, SHERMAN DAVID
Entity Type:Individual
Prefix:
First Name:SHERMAN
Middle Name:DAVID
Last Name:WADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 S ATLANTA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4306
Mailing Address - Country:US
Mailing Address - Phone:191-857-6880
Mailing Address - Fax:
Practice Address - Street 1:1231 S ATLANTA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4306
Practice Address - Country:US
Practice Address - Phone:918-576-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist