Provider Demographics
NPI:1073807665
Name:MENDOZA, JEFFREY A (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:11775 TECUMSEH CLINTON RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MI
Practice Address - Zip Code:49236-9541
Practice Address - Country:US
Practice Address - Phone:517-456-7449
Practice Address - Fax:517-456-6059
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2014-08-04
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Provider Licenses
StateLicense IDTaxonomies
VA0116023323207Q00000X
MI5101021421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine