MEDICARE: DR. TYRONE LUCAS ADAMS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	C 40791	CA

General Provider Information

NPI Number	:	1265637896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYRONE LUCAS ADAMS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 981044
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95798-1044
Country	:	US
Telephone Number	:	916-396-1656
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 CAPITOL AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-5005
Country	:	US
Telephone Number	:	916-552-9584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/08/2007

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