Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 18721 | CA |
N | 111NN0400X | Neurology | 18721 | CA |
NPI | 1508980707 |
---|---|
Provider Name | Dr. Robert Wesley Adams |
First Address | Sonoma, CA 95476-6906 |
Second Address | Sonoma, CA 95476-6906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0187210 | PIN (01) | CA |
U13612 | (02) | CA |
ZZZ56492Z | BLUE SHIELD (01) | CA |