Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | C2-0002872 | DE |
NPI | 1174528772 |
---|---|
Provider Name | Prentiss Wayne Adkins SR. |
First Address | Dagsboro, DE 19939-3839 |
Second Address | Dagsboro, DE 19939-3839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000167603 | (05) | DE |
210214 | COVENTRY (01) | DE |
2126367 | MAMSI (01) | DE |
52367105 | CAREFIRST MD (01) | DE |
876323 | AETNA (01) | DE |
B66598 | (02) | DE |