Provider Demographics
NPI:1700806767
Name:ADAMS, ALYCE R (MD,CDE)
Entity Type:Individual
Prefix:DR
First Name:ALYCE
Middle Name:R
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0001
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:3106 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5203
Practice Address - Country:US
Practice Address - Phone:318-322-0458
Practice Address - Fax:318-322-9352
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04520R174400000X
LAMD04520R207P00000X
LAMD.04520R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1689599Medicaid
LA5Y199Medicare PIN
LA5Y199Medicare ID - Type Unspecified
LAB97550Medicare UPIN
LA5Y199DJ97Medicare PIN