Provider Demographics
NPI:1043268899
Name:MEADOWS, TERRY RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:RANDALL
Last Name:MEADOWS
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 1:13737 NOEL RD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1331
Mailing Address - Country:US
Mailing Address - Phone:469-401-2386
Mailing Address - Fax:
Practice Address - Street 1:13737 NOEL RD
Practice Address - Street 2:SUITE 1600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-1331
Practice Address - Country:US
Practice Address - Phone:469-401-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30752207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC48428Medicare UPIN