Healthcare Provider Details

I. General information

NPI: 1467558569
Provider Name (Legal Business Name): CHARLES DAVID MEADOWS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WRIGHT ST
ARLINGTON TX
76012-4730
US

IV. Provider business mailing address

4910 CRANBROOK DR E
COLLEYVILLE TX
76034-4360
US

V. Phone/Fax

Practice location:
  • Phone: 817-277-1161
  • Fax: 817-261-8915
Mailing address:
  • Phone: 817-277-1161
  • Fax: 817-261-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD5794
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: