Provider Demographics
NPI:1639173420
Name:MEREDITH, JAMES THEROLD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THEROLD
Last Name:MEREDITH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:921 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-9183
Mailing Address - Country:US
Mailing Address - Phone:870-633-4711
Mailing Address - Fax:870-633-4850
Practice Address - Street 1:921 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-9183
Practice Address - Country:US
Practice Address - Phone:870-633-4711
Practice Address - Fax:870-633-4850
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
ARC5727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR13346000000OtherQUALCHOICE
ARP01915OtherNOVASYS
AR106020002Medicaid
AR106002001Medicaid
AR080077472OtherTRICARE
AR4032439OtherAETNA
AR080077472OtherRAILROAD MEDICARE
AR172348500OtherUS DEPT OF LABOR WC