Healthcare Provider Details

I. General information

NPI: 1487648697
Provider Name (Legal Business Name): SCOTT E ADAMS DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S HALCYON RD SUITE 101
ARROYO GRANDE CA
93420-3872
US

IV. Provider business mailing address

310 S HALCYON RD SUITE 101
ARROYO GRANDE CA
93420-3872
US

V. Phone/Fax

Practice location:
  • Phone: 805-481-0881
  • Fax: 805-481-0835
Mailing address:
  • Phone: 805-481-0881
  • Fax: 805-481-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number40580
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0600250001
License Number StateCA

VIII. Authorized Official

Name: DR. SCOTT E. ADAMS
Title or Position: OWNER
Credential: D.P.M.
Phone: 805-481-0881