Provider Demographics
NPI:1801243902
Name:WADE, LAURA KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:KATHERINE
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1600 W UNIVERSITY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3154
Mailing Address - Country:US
Mailing Address - Phone:928-223-4823
Mailing Address - Fax:202-381-9567
Practice Address - Street 1:1600 W UNIVERSITY AVE STE 112
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3154
Practice Address - Country:US
Practice Address - Phone:928-223-4823
Practice Address - Fax:202-381-9567
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ58932207V00000X, 207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology