Healthcare Provider Details

I. General information

NPI: 1891798245
Provider Name (Legal Business Name): JOHN RAYMOND ADAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN RAYMOND RIVERA MD

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 PEMBROOK PL
MANHATTAN KS
66502-7482
US

IV. Provider business mailing address

2735 PEMBROOK PL
MANHATTAN KS
66502-7482
US

V. Phone/Fax

Practice location:
  • Phone: 785-537-4990
  • Fax: 785-537-1938
Mailing address:
  • Phone: 785-537-4990
  • Fax: 785-537-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number04-26086
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number04-26086
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number04-26086
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: