Healthcare Provider Details

I. General information

NPI: 1356121081
Provider Name (Legal Business Name): MARK ADAMS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SW RAMSEY AVE
GRANTS PASS OR
97527-5554
US

IV. Provider business mailing address

2825 E BARNETT RD # MSS
MEDFORD OR
97504-8332
US

V. Phone/Fax

Practice location:
  • Phone: 541-472-7000
  • Fax: 541-472-7107
Mailing address:
  • Phone: 541-789-4200
  • Fax: 541-789-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10016546
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: