Provider Demographics
NPI:1013353655
Name:MEADOR, JEFF
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:MEADOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 TEJON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:303-778-2774
Practice Address - Street 1:65 TEJON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1221
Practice Address - Country:US
Practice Address - Phone:303-778-3304
Practice Address - Fax:303-778-2774
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist