Provider Demographics
NPI:1700862794
Name:ADAMS, ALLEN DALE (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:DALE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W LA PALMA AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2815
Mailing Address - Country:US
Mailing Address - Phone:714-772-8282
Mailing Address - Fax:714-772-6493
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6098
Practice Address - Country:US
Practice Address - Phone:925-225-5837
Practice Address - Fax:925-225-5838
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0820207RC0200X, 207RP1001X
CAA86964207RC0200X, 207RP1001X
PAMD456660207RP1001X
FLME132045207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77466ZMedicaid
CAET757WMedicare PIN
WA86964BMedicare PIN
CAET757VMedicare PIN
CAET757XMedicare PIN
CAI24945Medicare UPIN