Healthcare Provider Details

I. General information

NPI: 1073707949
Provider Name (Legal Business Name): CHARLES R ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N 15TH ST SUITE 14
NORFOLK NE
68701-3666
US

IV. Provider business mailing address

109 N 15TH ST SUITE 14
NORFOLK NE
68701-3666
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-0226
  • Fax:
Mailing address:
  • Phone: 402-371-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number16322
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: