Provider Demographics
NPI:1164436226
Name:ADAMS, ROBERT LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LOUIS
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HUMPHREYS CTR STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2352
Mailing Address - Country:US
Mailing Address - Phone:901-761-9030
Mailing Address - Fax:901-473-6505
Practice Address - Street 1:80 HUMPHREYS CTR STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2352
Practice Address - Country:US
Practice Address - Phone:901-761-9030
Practice Address - Fax:901-473-6505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11508208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0050596OtherBLUECROSS BLUESHIELD TN
TN4018746OtherAETNA
TN3016568Medicare PIN
TNA98056Medicare UPIN