Healthcare Provider Details

I. General information

NPI: 1467432385
Provider Name (Legal Business Name): STANLEY DAVID ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER SAN DIEGO (LAB DEPT) 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-5000
US

IV. Provider business mailing address

7390 VIA RIVERA
SAN DIEGO CA
92129-2270
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8211
  • Fax: 619-532-9403
Mailing address:
  • Phone: 858-484-2638
  • Fax: 619-532-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number01051264A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: