Healthcare Provider Details

I. General information

NPI: 1720175268
Provider Name (Legal Business Name): GREGG A ADAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE GENERAL SURGERY DEPT
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

751 S BASCOM AVE GENERAL SUGERY DEPT
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-6060
  • Fax:
Mailing address:
  • Phone: 408-885-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG70824
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG70824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: