Provider Demographics
NPI:1982640017
Name:ADAMS, BRADLEY J (DPM)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:ADAMS
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 1:734 S SHOOP AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1707
Mailing Address - Country:US
Mailing Address - Phone:419-337-8897
Mailing Address - Fax:419-337-4910
Practice Address - Street 1:734 S SHOOP AVE
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1707
Practice Address - Country:US
Practice Address - Phone:419-337-8897
Practice Address - Fax:419-337-4910
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36 002115213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0510807Medicaid
OH480001611OtherPALMETTO GBA RAILROAD MEDICARE
OH02037OtherPARAMOUNT
OH605732OtherBUCKEYE CHP
OH480001611OtherPALMETTO GBA RAILROAD MEDICARE
OH02037OtherPARAMOUNT