Healthcare Provider Details

I. General information

NPI: 1316733728
Provider Name (Legal Business Name): CHARLES ADAMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CLAIRE MALLORY ADAMS

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490A W ZIA RD STE 100
SANTA FE NM
87505-7007
US

IV. Provider business mailing address

490A W ZIA RD STE 100
SANTA FE NM
87505-7007
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5602
  • Fax:
Mailing address:
  • Phone: 505-913-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: