Basic Information
| Provider Information | |||||||||
| NPI: | 1477611077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIER | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4323 NW 36TH ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326056020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546465043 | ||||||||
| FaxNumber: | 3522656922 | ||||||||
| Practice Location | |||||||||
| Address1: | 1304 OAK ST | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329013111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217234723 | ||||||||
| FaxNumber: | 3217271448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 07/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | UO-1453 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | OS10956 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 002471000 | 05 | FL | MEDICAID |