Provider Demographics
NPI:1255536686
Name:ADAMS, JASON PHILLIP (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:PHILLIP
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 FARMINGTON AVE BLDG I-A
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4570
Mailing Address - Country:US
Mailing Address - Phone:505-675-7070
Mailing Address - Fax:505-675-2757
Practice Address - Street 1:2700 FARMINGTON AVE BLDG I-A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4570
Practice Address - Country:US
Practice Address - Phone:505-675-7070
Practice Address - Fax:505-675-2757
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239282208200000X, 208600000X
NMA-1678-122086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery