Provider Demographics
NPI:1033424189
Name:MEADOR, MICHAEL GREY JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GREY
Last Name:MEADOR
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:251 CROWN POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-1118
Mailing Address - Country:US
Mailing Address - Phone:817-489-7300
Mailing Address - Fax:817-489-7302
Practice Address - Street 1:251 CROWN POINTE BLVD
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-1118
Practice Address - Country:US
Practice Address - Phone:817-489-7300
Practice Address - Fax:817-489-7302
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2024-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare PIN