Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MB07991400 | NJ |
N | 207QS0010X | Family Doctor - Sports Medicine | 34.008291 | OH |
NPI | 1134191224 |
---|---|
Provider Name | Dr. Russell Libiore Adams |
First Address | Pittsburgh, PA 15275 |
Second Address | Pittsburgh, PA 15275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 25/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1010875560002 | (05) | PA |
H94361 | (02) | OH |
H94361 | (02) | PA |