Provider Demographics
NPI:1417393794
Name:ADAMS, DEREK JAMES SR (NREMT)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:JAMES
Last Name:ADAMS
Suffix:SR
Gender:M
Credentials:NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUILDING 301 ANDREWS AVE.
Mailing Address - Street 2:LYSTER ARMY HEALTH CLINIC
Mailing Address - City:FT. RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:931-338-7965
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 301 ANDREWS AVE.
Practice Address - Street 2:LYSTER ARMY HEALTH CLINIC
Practice Address - City:FT. RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:931-338-7965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1820386146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic