Provider Demographics
NPI:1639109739
Name:ADAMS, JOHN B (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11637
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-1637
Mailing Address - Country:US
Mailing Address - Phone:850-484-4080
Mailing Address - Fax:850-484-8801
Practice Address - Street 1:4901 MARKET PLACE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8986
Practice Address - Country:US
Practice Address - Phone:850-484-4080
Practice Address - Fax:850-484-8801
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16407208VP0014X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120868Medicaid
MS0800004168Medicare ID - Type Unspecified
MS00120868Medicaid