Provider Demographics
NPI:1912972365
Name:ADAMS, ALAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:W
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:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-0429
Mailing Address - Country:US
Mailing Address - Phone:719-530-2200
Mailing Address - Fax:719-530-2254
Practice Address - Street 1:8905 CAMERON MEADOW CIR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-1855
Practice Address - Country:US
Practice Address - Phone:719-239-1242
Practice Address - Fax:719-539-2254
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0047181207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100112990BMedicaid
KSB68730Medicare UPIN
KS024738Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #