Provider Demographics
NPI:1972641157
Name:ADAM, RICHARD C (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:ADAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100408
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-1708
Mailing Address - Country:US
Mailing Address - Phone:210-616-0871
Mailing Address - Fax:210-733-1473
Practice Address - Street 1:3026 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-7006
Practice Address - Country:US
Practice Address - Phone:210-616-0871
Practice Address - Fax:210-733-1473
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0751213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0751OtherSTATE LICENSE
TX130995704Medicaid
TX5069520001Medicare NSC
TX480022301Medicare PIN
TX130995704Medicaid
TX88J600Medicare PIN