Provider Demographics
NPI:1104818368
Name:ADAMS, KAREN S (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1512
Mailing Address - Country:US
Mailing Address - Phone:580-762-3342
Mailing Address - Fax:580-762-5841
Practice Address - Street 1:421 E HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1512
Practice Address - Country:US
Practice Address - Phone:580-762-3342
Practice Address - Fax:580-762-5841
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2009-12-16
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
OK15203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100201010AMedicaid
OK0004351236OtherAETNA
OK249341111Medicare PIN
OK0004351236OtherAETNA
OK100201010AMedicaid
OK080016576 DA8935Medicare ID - Type UnspecifiedRAILROAD MEDICARE