Provider Demographics
NPI:1871544825
Name:ADAMS, DAVID D (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:D
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2001 S WOODRUFF AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6374
Mailing Address - Country:US
Mailing Address - Phone:208-528-8777
Mailing Address - Fax:208-528-9777
Practice Address - Street 1:2001 S WOODRUFF AVE
Practice Address - Street 2:STE 5
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6374
Practice Address - Country:US
Practice Address - Phone:208-528-8777
Practice Address - Fax:208-528-9777
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-08363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806420200Medicaid
ID806420200Medicaid
IDP30715Medicare UPIN