Provider Demographics
NPI:1750372520
Name:MCADAMS, C GORDON (MD)
Entity type:Individual
Prefix:
First Name:C GORDON
Middle Name:
Last Name:MCADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:GORDON
Other - Last Name:MCADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4916 OVERTON PLZ
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4415
Mailing Address - Country:US
Mailing Address - Phone:888-804-3000
Mailing Address - Fax:817-334-0235
Practice Address - Street 1:4916 OVERTON PLZ
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4415
Practice Address - Country:US
Practice Address - Phone:888-804-3000
Practice Address - Fax:817-334-0235
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2576207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110360804Medicaid
TX110360801Medicaid
TX110360801Medicaid
TX110360804Medicaid
TX89Z300Medicare PIN