Healthcare Provider Details

I. General information

NPI: 1295049138
Provider Name (Legal Business Name): JOHN P ADAMS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DOCTORS DR
PANAMA CITY FL
32405-4559
US

IV. Provider business mailing address

200 DOCTORS DR
PANAMA CITY FL
32405-4559
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-1694
  • Fax:
Mailing address:
  • Phone: 850-769-1694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberME 0011044
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN P ADAMS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-769-1694