Healthcare Provider Details

I. General information

NPI: 1881682888
Provider Name (Legal Business Name): MARK HAWKINS ADAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 MCINTYRE ST
GOLDEN CO
80403
US

IV. Provider business mailing address

541 S LAHOMA AVE
NORMAN OK
73069-5525
US

V. Phone/Fax

Practice location:
  • Phone: 720-434-4876
  • Fax:
Mailing address:
  • Phone: 405-202-1616
  • Fax: 405-360-1309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number14739
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberDR.0059468
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: