Provider Demographics
NPI:1851553572
Name:GAAL, WADE R (MD)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:R
Last Name:GAAL
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 1:1701 W. CHARLESTON BLVD.,SUITE 670
Mailing Address - Street 2:ATTN: SANDRA EROSA, CREDENTIALING SPECIALIST
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-671-2355
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:5380 S RAINBOW BLVD STE 320
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1880
Practice Address - Country:US
Practice Address - Phone:702-405-8150
Practice Address - Fax:702-405-8116
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14059207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFM356ZMedicare PIN