Provider Demographics
NPI:1790226991
Name:WADE, FRANCIS III
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:WADE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GIM, 2ND FLOOR
Mailing Address - Street 2:1008 SOUTH SPRING
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1004
Mailing Address - Country:US
Mailing Address - Phone:314-977-5060
Mailing Address - Fax:314-977-1664
Practice Address - Street 1:1201 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-257-8222
Practice Address - Fax:314-257-8221
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020012722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine