Provider Demographics
NPI:1205887288
Name:ADAMS, BRENDA J (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:ADAMS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-887-6813
Mailing Address - Fax:208-887-6884
Practice Address - Street 1:3090 E GENTRY WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3501
Practice Address - Country:US
Practice Address - Phone:208-887-6813
Practice Address - Fax:208-887-6884
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2012-08-18
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Provider Licenses
StateLicense IDTaxonomies
IDM- 5264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20000368Medicare PIN