Provider Demographics
NPI:1982603601
Name:ADAMS, GLADYS A (PA-C)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:A
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 E WASHINGTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-1052
Mailing Address - Country:US
Mailing Address - Phone:602-340-1429
Mailing Address - Fax:602-340-1327
Practice Address - Street 1:809 E WASHINGTON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-1052
Practice Address - Country:US
Practice Address - Phone:602-340-9455
Practice Address - Fax:602-253-5359
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2146363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ442468Medicaid