Provider Demographics
NPI:1699809830
Name:WADE, BARBARA H (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:H
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8310
Mailing Address - Country:US
Mailing Address - Phone:407-390-1677
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:4300 BAYOU BLVD
Practice Address - Street 2:SUITE 17D
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2671
Practice Address - Country:US
Practice Address - Phone:850-470-8071
Practice Address - Fax:850-470-8073
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME51367207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046880100Medicaid
FL04601VMedicare PIN
FL04601TMedicare PIN
FL04601UMedicare PIN
C67312Medicare UPIN