Provider Demographics
NPI:1689685349
Name:MEREDITH, BILL ROBERT JR (MD)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:ROBERT
Last Name:MEREDITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2216 E 32ND ST
Mailing Address - Street 2:STE. 202
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3016
Mailing Address - Country:US
Mailing Address - Phone:417-782-2020
Mailing Address - Fax:417-782-7861
Practice Address - Street 1:2216 E 32ND ST
Practice Address - Street 2:STE. 202
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3016
Practice Address - Country:US
Practice Address - Phone:417-782-2020
Practice Address - Fax:417-782-7861
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7952207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200024008Medicaid
KS100257110AMedicaid
MOA11861Medicare UPIN
MO990001189Medicare ID - Type Unspecified