Provider Demographics
NPI:1326153842
Name:ADAM, TODD WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:WAYNE
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 1:4114 OAK BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3264
Mailing Address - Country:US
Mailing Address - Phone:281-286-4113
Mailing Address - Fax:
Practice Address - Street 1:711 W BAY AREA BLVD STE 408
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4041
Practice Address - Country:US
Practice Address - Phone:281-282-9300
Practice Address - Fax:281-338-6885
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8858208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T89SMedicare ID - Type Unspecified
TXG04745Medicare UPIN