Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 80041 | MS |
NPI | 1366518631 |
---|---|
Provider Name | Bobby Lester Adams |
First Address | Meridian, MS 39301-3916 |
Second Address | Meridian, MS 39301-3916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
730-15593 | BLUE CROSS ALABAMA (01) | MS |
P00229484 | MEDICARE RAILROAD (01) | MS |
T20890 | (02) | MS |