Provider Demographics
NPI:1619934940
Name:WADE, FRANK C JR (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:C
Last Name:WADE
Suffix:JR
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 23666
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3666
Mailing Address - Country:US
Mailing Address - Phone:601-200-4749
Mailing Address - Fax:601-200-5929
Practice Address - Street 1:360 SIMPSON HIGHWAY 149
Practice Address - Street 2:SUITE 370
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3841
Practice Address - Country:US
Practice Address - Phone:601-849-1530
Practice Address - Fax:601-849-1535
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09883351Medicaid
MS00123452Medicaid
MS00123452Medicaid
MSC48365Medicare UPIN
MS080004086Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE