Provider Demographics
NPI:1043224892
Name:MEADOR, GREGORY BRANT (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:BRANT
Last Name:MEADOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 PIKE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3118
Mailing Address - Country:US
Mailing Address - Phone:210-601-0438
Mailing Address - Fax:
Practice Address - Street 1:7400 BARLITE BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1308
Practice Address - Country:US
Practice Address - Phone:210-921-3599
Practice Address - Fax:210-921-3358
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4545146D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140125919Medicaid
TX8AL600OtherBCBS
TX8AL600OtherBCBS OF TX
TX85X813OtherBCBS
TX140125931Medicaid
TX8AL600OtherBCBS
TX85X813OtherBCBS
TXE58031Medicare UPIN
TX140125919Medicaid
TX930097281Medicare PIN