Provider Demographics
NPI:1588659668
Name:STINSON, WADE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:WILLIAM
Last Name:STINSON
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-376-1611
Mailing Address - Fax:352-379-2428
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-379-2428
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2013-05-07
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
AL11720208G00000X
FLME97635208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000041007Medicaid
AL051041007OtherBCBS OF ALABAMA
FL278075500Medicaid
ALC70433Medicare UPIN
AE171ZMedicare PIN
AL051041007OtherBCBS OF ALABAMA
FL278075500Medicaid