Provider Demographics
NPI:1710070685
Name:WADE, ANDREW LAMONT (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:LAMONT
Last Name:WADE
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 1:2100 MONTE CRISTO DR
Mailing Address - Street 2:STE C
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3198
Mailing Address - Country:US
Mailing Address - Phone:903-868-0634
Mailing Address - Fax:903-870-4064
Practice Address - Street 1:2100 MONTE CRISTO DR
Practice Address - Street 2:STE C
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3198
Practice Address - Country:US
Practice Address - Phone:903-868-0634
Practice Address - Fax:903-870-4064
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8962207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100210702Medicaid
00T84JMedicare ID - Type Unspecified
G10717Medicare UPIN