Provider Demographics
NPI:1669429049
Name:CEOLA, WADE M (MD)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:M
Last Name:CEOLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1906 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4227
Mailing Address - Country:US
Mailing Address - Phone:970-384-6770
Mailing Address - Fax:970-384-6610
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4227
Practice Address - Country:US
Practice Address - Phone:970-384-6770
Practice Address - Fax:970-384-6610
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001013105207T00000X
ARE1615207T00000X
CO53071207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2950416001OtherCIGNA HEALTHCARE
CO51383527Medicaid
AR5M325OtherHEALTH ADVANTAGE
MO02080001300OtherQUAL CHOICE
MO143659OtherBLUE CROSS/CHOICE
AR148899001Medicaid
AR5M325OtherARKANSAS BC/BS
WA0214842OtherDEPARTMENT OF LABOR WA
MO13751OtherCOX HEALTH PLANS UPI
MO468970OtherHEALTHLINK
MO0600090OtherUNITED HEALTHCARE
MO4188130001OtherCIGNA MEDICARE
MOH36801OtherUSPS (W/C)
AR5M325OtherARKANSAS FIRST SOURCE
MO18942OtherCOX HEALTH PLANS
MO205393804Medicaid
WA0214842OtherDEPARTMENT OF LABOR WA
MO02080001300OtherQUAL CHOICE
AR148899001Medicaid
MO0600090OtherUNITED HEALTHCARE
AR5M325OtherARKANSAS BC/BS
MO143659OtherBLUE CROSS/CHOICE
AR5M325OtherARKANSAS FIRST SOURCE
MO205393804Medicaid
AR5M325Medicare PIN