Provider Demographics
NPI:1851519318
Name:ADAMS, KENNETH PAUL (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:PAUL
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12412 PRISTINE COURT NORTHEAST
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-4315
Mailing Address - Country:US
Mailing Address - Phone:505-242-3330
Mailing Address - Fax:
Practice Address - Street 1:7593 W BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6154
Practice Address - Country:US
Practice Address - Phone:954-925-2740
Practice Address - Fax:954-212-0494
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS19414207WX0110X
TXT7469207WX0110X
CODR.0054870207WX0110X
NMA-1439-08207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32035837Medicaid