Provider Demographics
NPI:1255304739
Name:MENDEZ, RAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:D
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4980 DEL PUEBLO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3883
Mailing Address - Country:US
Mailing Address - Phone:702-408-8957
Mailing Address - Fax:702-243-4195
Practice Address - Street 1:4980 DEL PUEBLO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-3883
Practice Address - Country:US
Practice Address - Phone:702-408-8957
Practice Address - Fax:702-243-4195
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504064Medicaid
G32615Medicare UPIN
NV40666Medicare PIN