Provider Demographics
NPI:1093707606
Name:MENDEZ, ROBERT J (DO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3315 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3319
Mailing Address - Country:US
Mailing Address - Phone:757-399-0759
Mailing Address - Fax:757-397-8957
Practice Address - Street 1:3315 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3319
Practice Address - Country:US
Practice Address - Phone:757-399-0759
Practice Address - Fax:757-397-8957
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036928207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
150684200OtherOWCP FED WC VIA ACS
265207OtherBCBS OF VA
VA5828988Medicaid
A1798OtherMEDCOST
VA10010981OtherSENTARA
265207OtherPENINSULA HEALTHCARE INC
54-1951442OtherCORVEL WC PROVIDER NETWOR
9803412001OtherCIGNA
VA10010981OtherSENTARA PPO
54-1951442OtherMIDATLANTIC HEALTH SOLUTI
VA54-1951442OtherHEALTH NETWORK
VA200374OtherPHYSICIAN NETWORK
265207OtherPRIORITY HEALTH CARE INC
54-1951442OtherAETNA
265207OtherHEALTHKEEPERS
NC790618ZMedicaid
54-1951442OtherCORVEL WC PROVIDER NETWOR
NC790618ZMedicaid