Provider Demographics
NPI:1174572895
Name:ADAMS, ANTHONY W (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-725-4505
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:730 MALABAR RD
Practice Address - Street 2:SUITE B
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950-3140
Practice Address - Country:US
Practice Address - Phone:321-725-4505
Practice Address - Fax:321-409-6821
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117629207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020269900Medicaid
FLHU002ZMedicare PIN
MO005014713Medicare ID - Type Unspecified