Provider Demographics
NPI:1609860709
Name:ADAMS, SCOTT E (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S HALCYON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3872
Mailing Address - Country:US
Mailing Address - Phone:805-481-0881
Mailing Address - Fax:805-481-0835
Practice Address - Street 1:310 S HALCYON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3872
Practice Address - Country:US
Practice Address - Phone:805-481-0881
Practice Address - Fax:805-481-0835
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3834213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38340Medicaid
CA000E38340OtherBLUE SHIELD
CAU33783Medicare UPIN
CA000E38340OtherBLUE SHIELD
WE2834CMedicare PIN