Provider Demographics
NPI:1881682888
Name:ADAMS, MARK HAWKINS (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:HAWKINS
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 1:541 S LAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5525
Mailing Address - Country:US
Mailing Address - Phone:405-202-1616
Mailing Address - Fax:405-360-1309
Practice Address - Street 1:5920 MCINTYRE ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403
Practice Address - Country:US
Practice Address - Phone:720-434-4876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14739207RG0300X
CODR.0059468207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK610405700OtherDEPT OF LABOR
OK100130130AMedicaid
D38592Medicare UPIN
010018068Medicare PIN