Wade Etheredge, MD

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

J1992 Issued in TX

Practice address

2400 Round Rock Ave
Round Rock, TX 78681-4004

Phone

(512) 341-1000

NPI assigned

May 2, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273708800000",
    "number": "1801854500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5607 LANDS END ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787341515",
            "telephone_number": "512-266-2480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 ROUND ROCK AVE",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814004",
            "telephone_number": "512-341-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHEREDGE",
        "first_name": "WADE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2010-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "TX",
            "license": "J1992",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "J1992",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104414104",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Estioko Transport Services, LLC
• Christian Brenden Estrada, DPT
• Jasmin Estrada, LCSW
• Eta Transportation LLC
• Dana Etheredge
• Brooke Marie Evans
• Matthew Bruce Evans, PHARM.D.
• Sally Evans
• Evara Eldercare LLC
• William B Ewen, M.D.

• Emergency Medical Services (Emergency Medicine) Physician in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.