Basic Information
Provider Information
NPI: 1376956755
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAMS
FirstName: OLA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: AL ALI
OtherFirstName: OLA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 844658
Address2:  
City: DALLAS
State: TX
PostalCode: 752844658
CountryCode: US
TelephoneNumber: 2547242111
FaxNumber:  
Practice Location
Address1: 700 SCOTT AND WHITE DR
Address2:  
City: COLLEGE STATION
State: TX
PostalCode: 77845
CountryCode: US
TelephoneNumber: 9792070100
FaxNumber: 9792072161
Other Information
ProviderEnumerationDate: 06/03/2014
LastUpdateDate: 10/30/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XQ9100TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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