Provider Demographics
NPI:1477573327
Name:FUENTES, ADAN A (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAN
Middle Name:A
Last Name:FUENTES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1222 S PATTERSON BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2684
Mailing Address - Country:US
Mailing Address - Phone:937-496-2600
Mailing Address - Fax:937-496-2610
Practice Address - Street 1:1222 S PATTERSON BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2684
Practice Address - Country:US
Practice Address - Phone:937-496-2600
Practice Address - Fax:937-496-2610
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34008361207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI20904Medicare UPIN
OHFU4146527Medicare PIN
OHFU4146522Medicare PIN
OHFU4146524Medicare PIN
OHFU4146526Medicare PIN
OHFU4146521Medicare PIN
OHFU4146523Medicare PIN
OHFU4146525Medicare PIN