Provider Demographics
NPI:1174501811
Name:ADAMS, DENIS (PAC)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 HARVEST HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5826
Mailing Address - Country:US
Mailing Address - Phone:214-420-0650
Mailing Address - Fax:214-736-0512
Practice Address - Street 1:1402 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4774
Practice Address - Country:US
Practice Address - Phone:903-757-8878
Practice Address - Fax:903-757-5985
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02255363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P 42487Medicare UPIN
TX8C9752Medicare PIN
P 42487Medicare UPIN
TX116098802Medicaid
TX8C9752Medicare PIN