Provider Demographics
NPI:1275539991
Name:MEADOR, GINA L (DPH)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:L
Last Name:MEADOR
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-0467
Mailing Address - Country:US
Mailing Address - Phone:580-225-2121
Mailing Address - Fax:580-225-4216
Practice Address - Street 1:105 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4751
Practice Address - Country:US
Practice Address - Phone:580-225-2121
Practice Address - Fax:580-225-4216
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4966180001Medicare ID - Type Unspecified