Basic Information
| Provider Information | |||||||||
| NPI: | 1184889446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1330 | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730701330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053076668 | ||||||||
| FaxNumber: | 4057016170 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 E. CHERRY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CUSHING | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740234102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182250616 | ||||||||
| FaxNumber: | 9182253740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2008 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TEP5937 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 47055301100 | 05 | NE | MEDICAID |