Provider Demographics
NPI:1386646610
Name:ADAMSON, THERAN BRADFORD (MD)
Entity type:Individual
Prefix:DR
First Name:THERAN
Middle Name:BRADFORD
Last Name:ADAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1200 UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2355
Mailing Address - Country:US
Mailing Address - Phone:515-248-1447
Mailing Address - Fax:515-248-1440
Practice Address - Street 1:1200 UNIVERSITY AVE STE 120
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2355
Practice Address - Country:US
Practice Address - Phone:515-248-1500
Practice Address - Fax:515-248-1510
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-53395207QA0401X
IDM-12662207Q00000X
CO39950207Q00000X
FLME152384207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG44868Medicare UPIN
1196476Medicare PIN
G44868Medicare UPIN