Provider Demographics
NPI:1578533659
Name:MENDOZA, JOSE E III (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:MENDOZA
Suffix:III
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:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6461
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:440-960-0264
Practice Address - Street 1:1813 NAGEL RD STE 500
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-6401
Practice Address - Country:US
Practice Address - Phone:440-937-4600
Practice Address - Fax:440-937-4605
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-6480-M207P00000X
OH35066480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5619197341C96OtherBLUECROSS BLUESHIELD
OH0974594Medicaid
OH3025372Medicaid
OH0236248Medicaid
OH5619197341C96OtherBLUECROSS BLUESHIELD
F80354Medicare UPIN
OHME0761756Medicare PIN
OH0974594Medicaid
OH9389631Medicare PIN