Provider Demographics
NPI:1841498763
Name:MEREDICK, RICHARD B JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:MEREDICK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOSPITAL LOOP NE STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2128
Mailing Address - Country:US
Mailing Address - Phone:505-727-4430
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL LOOP NE STE 201
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2128
Practice Address - Country:US
Practice Address - Phone:505-727-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0471207X00000X, 174400000X
CAC56196207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841498763Medicaid
NMMD2007-0471OtherNM LICENSE