Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 0101048733 | VA |
NPI | 1144200049 |
---|---|
Provider Name | Dr. William Bruce Adams |
First Address | Manassas, VA 20112-8601 |
Second Address | Quantico, VA 22134-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 08/07/2007 |