Healthcare Provider Details

I. General information

NPI: 1982968574
Provider Name (Legal Business Name): ADAM LLOYD BINGHAM D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N ROOSEVELT DR STE 210
SEASIDE OR
97138-4604
US

IV. Provider business mailing address

2111 EXCHANGE ST
ASTORIA OR
97103-3329
US

V. Phone/Fax

Practice location:
  • Phone: 503-738-3002
  • Fax: 503-738-3005
Mailing address:
  • Phone: 503-325-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP196700
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: