Provider Demographics
NPI:1053388868
Name:ADAMS, JEROME MARK (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:MARK
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-3481
Mailing Address - Country:US
Mailing Address - Phone:940-569-3351
Mailing Address - Fax:940-569-3353
Practice Address - Street 1:501 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-3481
Practice Address - Country:US
Practice Address - Phone:940-569-3351
Practice Address - Fax:940-569-3353
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC5941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1150914-01Medicaid
TX00J22QMedicare ID - Type Unspecified
TX1150914-01Medicaid