Provider Demographics
NPI:1831352400
Name:WADE, RUSSELL G (CST CFA)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:G
Last Name:WADE
Suffix:
Gender:M
Credentials:CST CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32131
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-2131
Mailing Address - Country:US
Mailing Address - Phone:520-906-6112
Mailing Address - Fax:
Practice Address - Street 1:7842 S CASTLE BAY ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9227
Practice Address - Country:US
Practice Address - Phone:520-906-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist