Provider Demographics
NPI:1033101175
Name:MENDEZ, JOSE E (DO)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 PEMBROKE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2544
Mailing Address - Country:US
Mailing Address - Phone:954-431-7681
Mailing Address - Fax:954-431-7682
Practice Address - Street 1:12600 PEMBROKE RD STE 310
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2544
Practice Address - Country:US
Practice Address - Phone:954-431-7681
Practice Address - Fax:954-431-7682
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00246207N00000X
FLOS0007092207Q00000X
FLOS7092207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251021901Medicaid
G22900Medicare UPIN
G22900Medicare UPIN