Provider Demographics
NPI:1326019613
Name:ADAM, JEFFERY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:S
Last Name:ADAM
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 1:3170 KETTERING BLVD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:31 S STANFIELD RD
Practice Address - Street 2:STE 304
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2374
Practice Address - Country:US
Practice Address - Phone:937-440-7872
Practice Address - Fax:937-440-7874
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.042734207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000003863OtherANTHEM
D42734OtherHUMANA
OH0680759Medicaid
0640419OtherAETNA
290420811006OtherMEDICAL MUTUAL
1020049OtherUNITEDHEALTHCARE
0640419OtherAETNA
OH040003949Medicare PIN
OH0680759Medicaid