Provider Demographics
NPI:1659352219
Name:ADAMS, DERRICK H (DO)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:H
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 1:2295 FIELDSTONE DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648
Mailing Address - Country:US
Mailing Address - Phone:530-527-0414
Mailing Address - Fax:
Practice Address - Street 1:2295 FIELDSTONE DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648
Practice Address - Country:US
Practice Address - Phone:530-527-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8900207QA0505X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53955FMedicaid
CAGR0089250Medicaid
CA553955Medicare PIN
CAGR0089250Medicaid
CA553957Medicare PIN
CARHM53955FMedicaid