Provider Demographics
NPI:1497863419
Name:LA MENDOLA, STEPHEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:LA MENDOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:SUITE P2240
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1500
Mailing Address - Country:US
Mailing Address - Phone:409-899-4747
Mailing Address - Fax:409-899-4881
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:SUITE P2240
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1500
Practice Address - Country:US
Practice Address - Phone:409-899-4747
Practice Address - Fax:409-899-4881
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8718208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118886402Medicaid
89711FMedicare ID - Type Unspecified
E20809Medicare UPIN