Provider Demographics
NPI:1881748424
Name:MEADOR, JR, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:MEADOR, JR
Suffix:
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 1:300 E OSBORN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2347
Mailing Address - Country:US
Mailing Address - Phone:602-279-0800
Mailing Address - Fax:602-234-8494
Practice Address - Street 1:300 E OSBORN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2347
Practice Address - Country:US
Practice Address - Phone:602-279-0800
Practice Address - Fax:602-234-8494
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07831174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD44253Medicare UPIN