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General NPI Number Information
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NPI Number | 1861590986
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Entity Type | Individual
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Provider Name | ADAM W CHILDERS MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435
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Country | US
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Telephone | 307-754-3313
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Fax | 307-754-7448
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Provider Business Mailing Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435
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Country | US
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Telephone | 307-754-3313
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Fax | 307-754-7448
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 924
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11686
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License Number State | MT
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