Provider Demographics
NPI:1558357152
Name:SMITH, WADE HAMRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:HAMRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7012
Mailing Address - Country:US
Mailing Address - Phone:817-641-6258
Mailing Address - Fax:817-641-0980
Practice Address - Street 1:812 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7012
Practice Address - Country:US
Practice Address - Phone:817-641-6258
Practice Address - Fax:817-641-0980
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9673207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035613101Medicaid
TXC21970Medicare UPIN
TX035613101Medicaid