Provider Demographics
NPI:1346243516
Name:WADE, TERRY S (DO)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:S
Last Name:WADE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:255 S GRAND MESA DR
Mailing Address - Street 2:
Mailing Address - City:CEDAREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:81413-3822
Mailing Address - Country:US
Mailing Address - Phone:970-856-4111
Mailing Address - Fax:970-856-4114
Practice Address - Street 1:255 S GRAND MESA DR
Practice Address - Street 2:
Practice Address - City:CEDAREDGE
Practice Address - State:CO
Practice Address - Zip Code:81413-3822
Practice Address - Country:US
Practice Address - Phone:970-856-4111
Practice Address - Fax:970-856-4114
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-11-01
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Provider Licenses
StateLicense IDTaxonomies
CO32008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1721506OtherCIGNA
CO119646OtherSELECT NET PINNACOL WC
CO01320084Medicaid
CO39326OtherCO BLUE CROSS
CO841452365002OtherROCKY MOUNTAIN HEALTH PLA
CO1421447OtherFIRST HEALTH
CO4703170001OtherDMERC SUPPLIER
TN4087979OtherBLUE CROSS
CO4361601OtherAETNA
CO080120285OtherRAILROAD MEDICARE
1364OtherBLUE CROSS NASCO
TN4087979OtherBLUE CROSS
1364OtherBLUE CROSS NASCO