Provider Demographics
NPI:1770744211
Name:WADE, JUSTIN G (DPM)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:G
Last Name:WADE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 FOREST LN # 515057
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 N BELT LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1790
Practice Address - Country:US
Practice Address - Phone:972-288-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1972213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery