Healthcare Provider Details

I. General information

NPI: 1982603601
Provider Name (Legal Business Name): GLADYS A ADAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 E WASHINGTON ST SUITE 106
PHOENIX AZ
85034-1052
US

IV. Provider business mailing address

809 E WASHINGTON ST SUITE 106
PHOENIX AZ
85034-1052
US

V. Phone/Fax

Practice location:
  • Phone: 602-340-9455
  • Fax: 602-253-5359
Mailing address:
  • Phone: 602-340-1429
  • Fax: 602-340-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2146
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: