MEDICARE: JESSIE ADAME 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	H9743	TX
2	207ZF0201X	Forensic Pathology Physician	H9743	TX
3	202C00000X	Independent Medical Examiner Physician	H9743	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220032975	OTHER	TX	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1922002492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE ADAME M.D.

Provider Business Mailing Address
First Line	:	3007 WOODLAND HILLS DR # 123
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-1403
Country	:	US
Telephone Number	:	281-359-1953
Fax Number	:	281-657-6834

Provider Business Practice Location Address
First Line	:	3007 WOODLAND HILLS DR # 123
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-1403
Country	:	US
Telephone Number	:	281-359-1953
Fax Number	:	281-657-6834

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

Provider Enumeration Date	:	06/11/2005
Last Update Date	:	01/10/2017

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