Provider Demographics
NPI:1972159465
Name:ADAMS, MYRON DANIEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MYRON
Middle Name:DANIEL
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 NC HIGHWAY 242 N
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-7844
Mailing Address - Country:US
Mailing Address - Phone:919-207-4403
Mailing Address - Fax:
Practice Address - Street 1:3333 NC HIGHWAY 242 N
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-7844
Practice Address - Country:US
Practice Address - Phone:919-207-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001009308363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical