Provider Demographics
NPI:1477550242
Name:MENDEZ, J E (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:E
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:ERNESTO
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:20104 VICTORIA CHASE RD
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-6311
Mailing Address - Country:US
Mailing Address - Phone:432-528-2705
Mailing Address - Fax:
Practice Address - Street 1:20104 VICTORIA CHASE RD
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-4326
Practice Address - Country:US
Practice Address - Phone:432-528-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3552207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123682002Medicaid
TXD66976Medicare UPIN
TX123682002Medicaid