Provider Demographics
NPI:1679748537
Name:ADAM, IAN (MS, MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:ADAM
Suffix:
Gender:M
Credentials:MS, MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 305
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:5323 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4013
Practice Address - Country:US
Practice Address - Phone:727-848-4600
Practice Address - Fax:727-848-6131
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009511000Medicaid
FL2210259OtherGHI
FL46852OtherBCBS-FL
FL323667OtherAVMED
FLP00807385OtherRR MEDICARE
FL2210259OtherGHI
FLP00807385OtherRR MEDICARE