Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 41677 | MS |
Y | 103T00000X | Psychologist | 41677 | MS |
N | 2084N0400X | Neurologist | 41677 | MS |
NPI | 1003830563 |
---|---|
Provider Name | Robert Adams |
First Address | Jackson, MS 39202-2064 |
Second Address | Jackson, MS 39202-1689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03731341 | (05) | MS |