Provider Demographics
NPI:1346348059
Name:ADKINS, GARTH TODD (MD)
Entity Type:Individual
Prefix:
First Name:GARTH
Middle Name:TODD
Last Name:ADKINS
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 1:25840 CREEKBEND DR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-9519
Mailing Address - Country:US
Mailing Address - Phone:235-495-7004
Mailing Address - Fax:
Practice Address - Street 1:14050 NW 14 ST
Practice Address - Street 2:SUITE 190
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33025
Practice Address - Country:US
Practice Address - Phone:954-475-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115803207Q00000X
FLPA3755363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292472200Medicaid
FLP62676Medicare UPIN
FL292472200Medicaid
FLE7812ZMedicare PIN