Provider Demographics
NPI:1003800939
Name:MENDEZ, ELVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:M
Last Name:MENDEZ
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:941-255-3722
Mailing Address - Fax:941-255-3723
Practice Address - Street 1:22655 BAYSHORE RD
Practice Address - Street 2:STE 130
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2005
Practice Address - Country:US
Practice Address - Phone:941-255-3722
Practice Address - Fax:941-255-3723
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64431207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47861OtherBCBS
FL014287900Medicaid
FLF90243Medicare UPIN
FLF90243Medicare UPIN
FL47861ZMedicare ID - Type Unspecified