Provider Demographics
NPI:1023788734
Name:MEADOR, DARRELL DEWAYNE SR
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:DEWAYNE
Last Name:MEADOR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 W STURDIVANT ST
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63730-8065
Mailing Address - Country:US
Mailing Address - Phone:573-321-0113
Mailing Address - Fax:
Practice Address - Street 1:612 W STURDIVANT ST
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:MO
Practice Address - Zip Code:63730-8065
Practice Address - Country:US
Practice Address - Phone:573-321-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications