Provider Demographics
NPI:1730321860
Name:ADAMS, TAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:TAJ
Middle Name:
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 1:6750 WEST LOOP S
Mailing Address - Street 2:PO BOX 119
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4103
Mailing Address - Country:US
Mailing Address - Phone:713-800-3457
Mailing Address - Fax:
Practice Address - Street 1:6720 BERTNER AVE
Practice Address - Street 2:MC 4-217
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:832-355-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1955207P00000X
GA067378207P00000X
GA003870207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX301112401Medicaid
TX1730321860OtherTRICARE SOUTH
TX8DG073OtherBCBS
TX301112401Medicaid