Provider Demographics
NPI:1235294695
Name:SO, GERALD MENDOZA (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MENDOZA
Last Name:SO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4032 MCDERMOTT RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7733
Mailing Address - Country:US
Mailing Address - Phone:972-769-9000
Mailing Address - Fax:972-769-0035
Practice Address - Street 1:4032 MCDERMOTT RD
Practice Address - Street 2:STE. 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7733
Practice Address - Country:US
Practice Address - Phone:972-769-9000
Practice Address - Fax:972-769-0035
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2014-06-18
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Provider Licenses
StateLicense IDTaxonomies
TXK45722084N0402X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56045Medicare UPIN