Individual
MR. JORDAN BLAKE ADAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
750 MORTON BLVD, HAZARD, KY 41701-5002
(606) 439-1559
Mailing address
750 MORTON BLVD, HAZARD, KY 41701-9469
(606) 439-1559
(606) 436-6988
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04299
KY
207Q00000X
Family Medicine Physician
52111
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
521117
—
SC
01
—
SCE2356067
MEDICARE PIN
SC
01
—
SCE2356084
MEDICARE PIN
SC
01
—
SCE235J577
MEDICARE PIN
SC
Enumeration date
06/18/2015
Last updated
06/15/2021
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