Provider Demographics
NPI:1174964654
Name:JESPERSEN, WADE ALLAN (DPM)
Entity type:Individual
Prefix:DR
First Name:WADE
Middle Name:ALLAN
Last Name:JESPERSEN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:14050 N 83RD AVE
Mailing Address - Street 2:STE 290
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5650
Mailing Address - Country:US
Mailing Address - Phone:888-495-4489
Mailing Address - Fax:602-865-8090
Practice Address - Street 1:19350 E SILVER CREEK LN
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9064
Practice Address - Country:US
Practice Address - Phone:480-718-5400
Practice Address - Fax:877-666-4624
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2019-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASC006516213ES0103X
AZ0843213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery