Provider Demographics
NPI:1013996016
Name:PAUL, ADAM B (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:B
Last Name:PAUL
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:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:734 ELM ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1934
Practice Address - Country:US
Practice Address - Phone:541-812-5111
Practice Address - Fax:541-812-5127
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27919208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0584862Medicaid
MN343664100Medicaid
MNHP42381OtherHEALTH PARTNERS
MN443R3PAOtherBCBS
MN132075OtherUCARE
410849339 56001 H007OtherCHAMPUS
MN1202874OtherMEDICA
MN2178714OtherAMERICAS PPO
MNNA2951041335OtherPREFERRED ONE
MNNA2951041335OtherPREFERRED ONE
MNHP42381OtherHEALTH PARTNERS