Provider Demographics
NPI:1730318148
Name:ADAJAR, ALLAN ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:ADAM
Last Name:ADAJAR
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 1:2100 OCOEE APOPKA RD STE 220
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-9210
Mailing Address - Country:US
Mailing Address - Phone:407-303-4190
Mailing Address - Fax:407-303-4192
Practice Address - Street 1:2100 OCOEE APOPKA RD STE 220
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-9210
Practice Address - Country:US
Practice Address - Phone:407-303-4190
Practice Address - Fax:407-303-4192
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124772207V00000X
TXN5518207V00000X
FLME143561207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124772Medicaid
FL105789200Medicaid
IL1730318148OtherINDIVIDUAL PROVIDER NPI
ILF400193284OtherINDIVIDUAL PROVIDER MEDICARE PTAN
IL1396142857OtherEMPLOYER NPI NUMBER