MEDICARE: DR. TRISTAN FLYNN MEADOR MD

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	207P00000X	Emergency Medicine Physician	D0077267	MD
2	207P00000X	Emergency Medicine Physician	DR.0058067	CO

General Provider Information

NPI Number	:	1679872485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRISTAN FLYNN MEADOR MD

Provider Business Mailing Address
First Line	:	PO BOX 110429
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80042-0429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15100 E 104TH AVE
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-8611
Country	:	US
Telephone Number	:	303-338-4545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	02/05/2025

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