Provider Demographics
NPI:1134488174
Name:MEDDERS, GINGER GLADDEN (MD)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:GLADDEN
Last Name:MEDDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:LEE
Other - Last Name:GLADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-364-4200
Mailing Address - Fax:314-364-6321
Practice Address - Street 1:3501 WE KNIGHT DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6254
Practice Address - Country:US
Practice Address - Phone:479-709-6700
Practice Address - Fax:479-709-6710
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.33375207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine