Provider Demographics
NPI:1417136086
Name:MEREDITH, SHIRLEY JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:JEAN
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4905
Mailing Address - Country:US
Mailing Address - Phone:502-708-2780
Mailing Address - Fax:502-805-0788
Practice Address - Street 1:125 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4905
Practice Address - Country:US
Practice Address - Phone:502-708-2780
Practice Address - Fax:502-805-0788
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049920207R00000X
OH35. 072880207R00000X
MS16175208D00000X
KY41773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice