Provider Demographics
NPI:1477060572
Name:MCGEHEE, DAVID WADE (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WADE
Last Name:MCGEHEE
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 1:3627 NICOLLET AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1256
Mailing Address - Country:US
Mailing Address - Phone:612-730-6015
Mailing Address - Fax:
Practice Address - Street 1:2428 E 117TH ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1269
Practice Address - Country:US
Practice Address - Phone:612-444-3000
Practice Address - Fax:612-444-9000
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12604363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant