Provider Demographics
NPI:1215901772
Name:MEADOWS, PERRY (MD)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W BROADWAY
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2129
Mailing Address - Country:US
Mailing Address - Phone:502-585-7991
Mailing Address - Fax:502-585-7998
Practice Address - Street 1:305 W BROADWAY
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2129
Practice Address - Country:US
Practice Address - Phone:502-585-7991
Practice Address - Fax:502-585-7998
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-7052207Q00000X
KY40029207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine