Provider Demographics
NPI:1679559439
Name:ANDERSON, WADE E (MD)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:780 KUENZLI ST
Mailing Address - Street 2:STE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0845
Mailing Address - Country:US
Mailing Address - Phone:775-982-5068
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:1260 NEVADA PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-9871
Practice Address - Country:US
Practice Address - Phone:775-575-7171
Practice Address - Fax:775-575-7227
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV15034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP001900008OtherRR MEDICARE
NV11179859OtherCAQH
NV1679559439Medicaid
IA2571844Medicaid
IA1571844Medicaid
IA1679559439Medicaid
NV1679559439Medicaid
IA1571844Medicaid
IAI13029Medicare PIN