Provider Demographics
NPI:1023523644
Name:WADE, DILLON TRENT (PA-C)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:TRENT
Last Name:WADE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BOURLAND RD STE 170
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3592
Mailing Address - Country:US
Mailing Address - Phone:817-741-2001
Mailing Address - Fax:
Practice Address - Street 1:100 BOURLAND RD STE 170
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3592
Practice Address - Country:US
Practice Address - Phone:817-741-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical