Provider Demographics
NPI:1962593731
Name:MEADORS, MARK ALLEN (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:MEADORS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 372
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5525
Practice Address - Fax:573-331-5558
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO116170207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245312509Medicaid
MO901284OtherHEALTHLINK
MOP00607763OtherRR MCR
MO1962593731OtherIL MCD
MO146746OtherHEALTH ALLIANCE
MO567604OtherBCBS
H34598Medicare UPIN
MO146746OtherHEALTH ALLIANCE