Provider Demographics
NPI:1841382082
Name:ADAMS, BOBBY JO (DO)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:JO
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 NE 130TH LN.
Mailing Address - Street 2:#220
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-883-4988
Mailing Address - Fax:425-899-6078
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:#220
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-883-4988
Practice Address - Fax:425-899-6078
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000809207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
16179OtherL&I
WA1734003Medicaid
000100034Medicare ID - Type Unspecified
WA1734003Medicaid