Provider Demographics
NPI:1073573648
Name:MEADOR, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MEADOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N. MAIN STREET
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-8572
Mailing Address - Country:US
Mailing Address - Phone:817-625-4254
Mailing Address - Fax:817-740-8600
Practice Address - Street 1:2106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-8511
Practice Address - Country:US
Practice Address - Phone:817-625-4254
Practice Address - Fax:817-740-8600
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5625208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154004901Medicaid
H21850Medicare UPIN
TX8A0358Medicare ID - Type Unspecified