Provider Demographics
NPI:1376245324
Name:DAZELLE, WAYDE DH (MD, MS)
Entity Type:Individual
Prefix:
First Name:WAYDE
Middle Name:DH
Last Name:DAZELLE
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:WADE
Other - Middle Name:DH
Other - Last Name:DAZELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1043
Mailing Address - Country:US
Mailing Address - Phone:614-355-9000
Mailing Address - Fax:614-355-9010
Practice Address - Street 1:1405 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1043
Practice Address - Country:US
Practice Address - Phone:614-355-9000
Practice Address - Fax:614-355-9010
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program