Provider Demographics
NPI:1750331757
Name:DEUTCHMAN, ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:DEUTCHMAN
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 1:203 S DAISY ST
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-0000
Mailing Address - Country:US
Mailing Address - Phone:208-756-5600
Mailing Address - Fax:208-756-4169
Practice Address - Street 1:805 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-0000
Practice Address - Country:US
Practice Address - Phone:208-756-6212
Practice Address - Fax:208-756-6336
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424797208600000X
CODR-33966208600000X
MO119790208600000X
IDM-9041208600000X
MT11652208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery