Healthcare Provider Details

I. General information

NPI: 1417161233
Provider Name (Legal Business Name): ANNETTE P MEADOR, MD P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 CRESTWOOD RD
N LITTLE ROCK AR
72116
US

IV. Provider business mailing address

P O BOX 308
CONWAY AR
72033
US

V. Phone/Fax

Practice location:
  • Phone: 501-771-2835
  • Fax: 501-758-6215
Mailing address:
  • Phone: 501-771-4370
  • Fax: 501-327-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberC6185
License Number StateAR

VIII. Authorized Official

Name: ANNETTE P MEADOR
Title or Position: OWNER
Credential: M.D.
Phone: 501-771-2835