Provider Demographics
NPI:1407858624
Name:ADKISON, H. WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:H.
Middle Name:WILLIAM
Last Name:ADKISON
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 1:735 VIA MANZANA
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5411
Mailing Address - Country:US
Mailing Address - Phone:505-758-2224
Mailing Address - Fax:505-758-4903
Practice Address - Street 1:735 VIA MANZANA
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5411
Practice Address - Country:US
Practice Address - Phone:505-758-2224
Practice Address - Fax:505-758-4903
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM74-111207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01404Medicaid
NM01404Medicaid