Provider Demographics
NPI:1295968311
Name:PASTERNAK, ADAM P (DO, CAQSM)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:P
Last Name:PASTERNAK
Suffix:
Gender:M
Credentials:DO, CAQSM
Other - Prefix:
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Mailing Address - Street 1:5535 S WILLIAMSON BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-8321
Mailing Address - Country:US
Mailing Address - Phone:386-231-6300
Mailing Address - Fax:386-322-6165
Practice Address - Street 1:5535 S WILLIAMSON BLVD STE 700
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-8321
Practice Address - Country:US
Practice Address - Phone:386-231-6300
Practice Address - Fax:386-322-6165
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014024991207QS0010X
FLOS16317207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine