=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447597596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRED ADAMS M.D. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2013
-----------------------------------------------------
Last Update Date | 01/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 FLORIDA AVE SUITE 205 A
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-4422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-575-5844
-----------------------------------------------------
Fax | 209-575-5846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 FLORIDA AVE STE 205A
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-4445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-575-5844
-----------------------------------------------------
Fax | 209-575-5846
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D. PRESIDENT
-----------------------------------------------------
Name | DR. FRED ADAMS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 209-575-5844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number | A320550
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------