Individual
KENYON M. MEADOWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4247 W. MAIN STREET, DOTHAN, AL 36305-1062
(334) 793-3212
(334) 671-0484
Mailing address
2234 COLONIAL BLVD, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
00027449
AL
2085R0001X
Radiation Oncology Physician
61801
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831385632
MEDICAID GROUP AL
AL
05
—
1891726451
—
AL
05
—
276328100
—
FL
05
—
400647716A
—
GA
01
—
510-10021
BCBS OF AL
AL
01
—
P00348790
RAILROAD MEDICARE PIN #
AL
Enumeration date
07/05/2006
Last updated
11/05/2024
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