Healthcare Provider Details

I. General information

NPI: 1386646610
Provider Name (Legal Business Name): THERAN BRADFORD ADAMSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 UNIVERSITY AVE STE 120
DES MOINES IA
50314-2355
US

IV. Provider business mailing address

1200 UNIVERSITY AVE STE 200
DES MOINES IA
50314-2355
US

V. Phone/Fax

Practice location:
  • Phone: 515-248-1500
  • Fax: 515-248-1510
Mailing address:
  • Phone: 515-248-1447
  • Fax: 515-248-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-12662
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39950
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD-53395
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberME152384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: