Provider Demographics
NPI:1871565739
Name:WADAS, DARRELL D (MD)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:D
Last Name:WADAS
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:PO BOX 12330
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0023
Mailing Address - Country:US
Mailing Address - Phone:602-761-0707
Mailing Address - Fax:
Practice Address - Street 1:127 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5646
Practice Address - Country:US
Practice Address - Phone:602-761-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13563207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ275215Medicaid
AZ275215Medicaid
AZMD13563Medicare ID - Type Unspecified