Provider Demographics
NPI:1861853988
Name:WADE, JACQUELINE KATE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:KATE
Last Name:WADE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:JBSA FORT SAM HOUSTON
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-9928
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:JBSA FORT SAM HOUSTON
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-9928
Practice Address - Fax:210-916-9332
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2019-07-24
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Provider Licenses
StateLicense IDTaxonomies
NE30360208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics