Provider Demographics
NPI:1477657625
Name:ADAMS, ELLIOTT LEIGH (HD)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:LEIGH
Last Name:ADAMS
Suffix:
Gender:M
Credentials:HD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7248 S LAND PARK DR
Mailing Address - Street 2:STE 206
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3662
Mailing Address - Country:US
Mailing Address - Phone:916-392-7900
Mailing Address - Fax:916-392-7911
Practice Address - Street 1:7248 S LAND PARK DR
Practice Address - Street 2:STE 206
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3662
Practice Address - Country:US
Practice Address - Phone:916-392-7900
Practice Address - Fax:916-392-7911
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24813207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A248130Medicare ID - Type Unspecified
A24146Medicare UPIN