Healthcare Provider Details

I. General information

NPI: 1265637896
Provider Name (Legal Business Name): TYRONE LUCAS ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CAPITOL AVE
SACRAMENTO CA
95814-5005
US

IV. Provider business mailing address

PO BOX 981044
WEST SACRAMENTO CA
95798-1044
US

V. Phone/Fax

Practice location:
  • Phone: 916-552-9584
  • Fax:
Mailing address:
  • Phone: 916-396-1656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC 40791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: