Provider Demographics
NPI:1437383825
Name:MENDOZA, YADER (MD)
Entity Type:Individual
Prefix:
First Name:YADER
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YADER
Other - Middle Name:ALBERTO
Other - Last Name:MENDOZA GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1060 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2494
Mailing Address - Country:US
Mailing Address - Phone:405-378-5491
Mailing Address - Fax:405-378-5492
Practice Address - Street 1:1060 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2494
Practice Address - Country:US
Practice Address - Phone:405-378-5491
Practice Address - Fax:405-378-5492
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27194207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty