Provider Demographics
NPI:1184613929
Name:WERNECKE, WADE CARL (MD)
Entity type:Individual
Prefix:DR
First Name:WADE
Middle Name:CARL
Last Name:WERNECKE
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 1:300 WERNER ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6406
Mailing Address - Country:US
Mailing Address - Phone:501-622-1043
Mailing Address - Fax:501-622-1199
Practice Address - Street 1:300 WERNER ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6406
Practice Address - Country:US
Practice Address - Phone:501-622-1043
Practice Address - Fax:501-622-1199
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31819207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2M151WEOtherBCBS
MN053502800Medicaid
MNHP31594OtherHEALTHPARTNERS
AR5H0526972OtherMEDICARELINKED
AR5H0526972OtherMEDICARELINKED
MN089000364Medicare ID - Type Unspecified