Provider Demographics
NPI:1891726451
Name:MEADOWS, KENYON M (MD)
Entity Type:Individual
Prefix:
First Name:KENYON
Middle Name:M
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:4247 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1062
Practice Address - Country:US
Practice Address - Phone:334-793-3212
Practice Address - Fax:334-671-0484
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000274492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA400647716AMedicaid
AL510-10021OtherBCBS OF AL
FL276328100Medicaid
AL1831385632OtherMEDICAID GROUP AL
AL1891726451Medicaid
ALP00348790OtherRAILROAD MEDICARE PIN #
ALP00348790OtherRAILROAD MEDICARE PIN #