Provider Demographics
NPI:1538178751
Name:MEADOWS, MARK ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4680 DRUSILLA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-6947
Mailing Address - Country:US
Mailing Address - Phone:225-926-4956
Mailing Address - Fax:
Practice Address - Street 1:8777 BLUEBONNET BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2818
Practice Address - Country:US
Practice Address - Phone:225-767-5525
Practice Address - Fax:225-767-5339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA022311207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA022311OtherMEDICAL LICENSE
LA1539520Medicaid
LA022311OtherMEDICAL LICENSE
LA1539520Medicaid