Provider Demographics
NPI:1700879293
Name:ADAMS, BRADLEY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:SCOTT
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 SW PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-4465
Mailing Address - Country:US
Mailing Address - Phone:541-276-4642
Mailing Address - Fax:541-276-4975
Practice Address - Street 1:3207 SW PERKINS AVENUE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3215
Practice Address - Country:US
Practice Address - Phone:541-276-4642
Practice Address - Fax:541-276-4975
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23266174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH03868Medicare UPIN
ORR117570Medicare ID - Type Unspecified