Healthcare Provider Details

I. General information

NPI: 1073573648
Provider Name (Legal Business Name): KAREN MEADOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 N MAIN ST
FORT WORTH TX
76164-8511
US

IV. Provider business mailing address

2100 N. MAIN STREET SUITE 109
FORT WORTH TX
76164-8572
US

V. Phone/Fax

Practice location:
  • Phone: 817-625-4254
  • Fax: 817-740-8600
Mailing address:
  • Phone: 817-625-4254
  • Fax: 817-740-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK5625
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: