Provider Demographics
NPI:1881782373
Name:WADE, RANDALL WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:WILLIAM
Last Name:WADE
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 1:120 SOUTH CENTRAL EXPRESSWAY
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3753
Mailing Address - Country:US
Mailing Address - Phone:972-548-5388
Mailing Address - Fax:972-548-7318
Practice Address - Street 1:120 S CENTRAL EXPY
Practice Address - Street 2:SUITE 124
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3742
Practice Address - Country:US
Practice Address - Phone:972-548-5388
Practice Address - Fax:972-548-7318
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7117207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine