Provider Demographics
NPI:1154388965
Name:ADAMS, FRED (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRAIDON
Other - Middle Name:
Other - Last Name:BABANEJAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 FLORIDA AVE
Mailing Address - Street 2:STE 205A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:93350-4422
Mailing Address - Country:US
Mailing Address - Phone:209-575-5844
Mailing Address - Fax:209-575-5846
Practice Address - Street 1:1400 FLORIDA AVE
Practice Address - Street 2:STE 205A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:93350-4422
Practice Address - Country:US
Practice Address - Phone:209-575-5844
Practice Address - Fax:209-575-5846
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32055207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA320550Medicaid
CAOOA320550Medicare ID - Type Unspecified
E34259Medicare UPIN