Provider Demographics
NPI:1629191259
Name:MENDEZ, GARY BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRIAN
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 W THORNBUSH PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1845
Mailing Address - Country:US
Mailing Address - Phone:520-531-1313
Mailing Address - Fax:520-544-8197
Practice Address - Street 1:7070 N ORACLE RD
Practice Address - Street 2:STE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4337
Practice Address - Country:US
Practice Address - Phone:520-544-9696
Practice Address - Fax:520-544-8197
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z2946OtherHEALTHNET
AZAZ0938210OtherBSBC
AZ650311OtherUNITED HEALTH CARE
AZ650311OtherUNITED HEALTH CARE
AZZ72760Medicare ID - Type Unspecified