Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 3953 | NC |
NPI | 1396797627 |
---|---|
Provider Name | Dr. John Thomas Meadows |
First Address | Jacksonville, NC 28546-3217 |
Second Address | Jacksonville, NC 28546-3217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 04/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
744032 | UNITED CONCORDIA (01) | NC |
8995847 | (05) | NC |
95847 | BCBS (01) | NC |
T63801 | (02) | NC |