Provider Demographics
NPI:1447597596
Name:FRED ADAMS M.D. INC
Entity Type:Organization
Organization Name:FRED ADAMS M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-575-5844
Mailing Address - Street 1:1400 FLORIDA AVE STE 205A
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4445
Mailing Address - Country:US
Mailing Address - Phone:209-575-5844
Mailing Address - Fax:209-575-5846
Practice Address - Street 1:1400 FLORIDA AVE
Practice Address - Street 2:SUITE 205 A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4422
Practice Address - Country:US
Practice Address - Phone:209-575-5844
Practice Address - Fax:209-575-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA320550305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A320550Medicaid
CA00A320550Medicaid