Provider Demographics
NPI:1174528772
Name:ADKINS, PRENTISS WAYNE SR (DO)
Entity type:Individual
Prefix:
First Name:PRENTISS
Middle Name:WAYNE
Last Name:ADKINS
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29475 VINES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-3839
Mailing Address - Country:US
Mailing Address - Phone:302-732-9593
Mailing Address - Fax:302-732-9598
Practice Address - Street 1:29475 VINES CREEK RD
Practice Address - Street 2:
Practice Address - City:DAGSBORO
Practice Address - State:DE
Practice Address - Zip Code:19939-3839
Practice Address - Country:US
Practice Address - Phone:302-732-9593
Practice Address - Fax:302-732-9598
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0002872207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE876323OtherAETNA
DE52367105OtherCAREFIRST MD
DE210214OtherCOVENTRY
DE2126367OtherMAMSI
DE0000167603Medicaid
DE0000167603Medicaid
DE2126367OtherMAMSI