Provider Demographics
NPI:1023207016
Name:MEREDITH, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:424 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-4152
Mailing Address - Country:US
Mailing Address - Phone:407-886-0611
Mailing Address - Fax:407-886-2817
Practice Address - Street 1:502 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7325
Practice Address - Country:US
Practice Address - Phone:869-571-8543
Practice Address - Fax:386-878-4967
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME102682208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG0576ZMedicare UPIN