Provider Demographics
NPI:1184672404
Name:MEFFORD, IVAN N (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:N
Last Name:MEFFORD
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 1:1505 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3218
Mailing Address - Country:US
Mailing Address - Phone:281-342-9500
Mailing Address - Fax:281-342-6667
Practice Address - Street 1:1505 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3218
Practice Address - Country:US
Practice Address - Phone:281-342-9500
Practice Address - Fax:281-342-6667
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101938201Medicaid
TXG71955Medicare UPIN
TX81603KMedicare ID - Type Unspecified