Provider Demographics
NPI:1861427304
Name:CADE, JERRY DAVID (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:DAVID
Last Name:CADE
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 1:125 COPPERHEAD BND
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-7357
Mailing Address - Country:US
Mailing Address - Phone:828-675-5300
Mailing Address - Fax:828-675-5300
Practice Address - Street 1:125 COPPERHEAD BND
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-7357
Practice Address - Country:US
Practice Address - Phone:828-675-5300
Practice Address - Fax:828-675-5300
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19787174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0081POtherBCBS SWINGBED
NC8920642Medicaid
NC411013849OtherMEDICARE RAILROAD
NC8907673OtherMEDICAID PHYSICIAN
NC014MXOtherBCBS LABS
NC20642OtherBCBS INDIVIDUAL PROVIDER
NC235013BOtherMEDICARE PHYSICIAN
NC00513OtherBCBS
NC235013OtherMEDICARE PHYSICIAN
NC34U011OtherMEDICARE SWINGBED
NC07673OtherBCBS PHYSICIAN
NC3400011OtherMEDCAID
NC340011Medicare Oscar/Certification
NC00513OtherBCBS
NC20642OtherBCBS INDIVIDUAL PROVIDER
NC014MXOtherBCBS LABS