MEDICARE: IVAN N MEFFORD MD PHD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K0524	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF3269	OTHER	TX	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1598858391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVAN N MEFFORD MD PHD PA

Provider Business Mailing Address
First Line	:	1505 LIBERTY ST
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3218
Country	:	US
Telephone Number	:	281-342-9500
Fax Number	:	281-342-6667

Provider Business Practice Location Address
First Line	:	1505 LIBERTY ST
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3218
Country	:	US
Telephone Number	:	281-342-9500
Fax Number	:	281-342-6667

Authorized Official
Title or Position	:	OWNER
Name	:	DR. IVAN NEWTON MEFFORD
Credential	:	MD
Telephone Number	:	281-342-9500

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	02/13/2025

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Directions to “IVAN N MEFFORD MD PHD PA ” Practice Location

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