Provider Demographics
NPI:1457576647
Name:ADAMS, JOHN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:711 E END BLVD S
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5615
Mailing Address - Country:US
Mailing Address - Phone:903-938-4363
Mailing Address - Fax:903-935-7394
Practice Address - Street 1:711 E END BLVD S
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5615
Practice Address - Country:US
Practice Address - Phone:903-938-4363
Practice Address - Fax:903-935-7394
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC12599Medicare UPIN
TX00BB17Medicare ID - Type Unspecified