Provider Demographics
NPI:1700869898
Name:MEADOR, ANNETTE P (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:P
Last Name:MEADOR
Suffix:
Gender:F
Credentials:MD
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 308
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-0308
Mailing Address - Country:US
Mailing Address - Phone:501-771-4370
Mailing Address - Fax:
Practice Address - Street 1:2524 CRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7623
Practice Address - Country:US
Practice Address - Phone:501-771-2835
Practice Address - Fax:501-945-7656
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6185208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD84278Medicare UPIN
AR53606Medicare ID - Type Unspecified