Provider Demographics
NPI:1710957345
Name:FARROW, WADE P (MD)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:P
Last Name:FARROW
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 1:5320 MIRABELL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-6496
Mailing Address - Country:US
Mailing Address - Phone:979-777-6730
Mailing Address - Fax:
Practice Address - Street 1:1605 ROCK PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8358
Practice Address - Country:US
Practice Address - Phone:979-764-4325
Practice Address - Fax:979-764-4345
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1166592083P0011X
TXL10672083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710957345Medicaid