Provider Demographics
NPI:1598858391
Name:IVAN N MEFFORD MD PHD PA
Entity Type:Organization
Organization Name:IVAN N MEFFORD MD PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:MEFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-342-9500
Mailing Address - Street 1:1601 MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3247
Mailing Address - Country:US
Mailing Address - Phone:281-342-9500
Mailing Address - Fax:281-342-6667
Practice Address - Street 1:1601 MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3247
Practice Address - Country:US
Practice Address - Phone:281-342-9500
Practice Address - Fax:281-342-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDF3269OtherMEDICARE RAILROAD
TX00X055Medicare PIN
TXG71955Medicare UPIN