Healthcare Provider Details

I. General information

NPI: 1467403733
Provider Name (Legal Business Name): WILLIAM D ADAMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 RIGBY LAKE DR SUITE 115
RIGBY ID
83442-5192
US

IV. Provider business mailing address

711 RIGBY LAKE DR SUITE 115
RIGBY ID
83442-5192
US

V. Phone/Fax

Practice location:
  • Phone: 208-745-5021
  • Fax: 208-745-5026
Mailing address:
  • Phone: 208-745-5021
  • Fax: 208-745-5026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0252
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: