Provider Demographics
NPI:1659316677
Name:MENDEZ, DAVID ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ENRIQUE
Last Name:MENDEZ
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 1:212 PHOENIX CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-3908
Mailing Address - Country:US
Mailing Address - Phone:865-577-6475
Mailing Address - Fax:
Practice Address - Street 1:212 PHOENIX CT
Practice Address - Street 2:SUITE 1
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-3908
Practice Address - Country:US
Practice Address - Phone:865-577-6475
Practice Address - Fax:865-577-7942
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35439208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3495782Medicaid
TN4111398OtherBLUE CROSS
TN3496790Medicaid
KY64060387Medicaid
TNTN0102OtherJOHN DEERE HEALTH
TN4050879OtherBLUE CROSS
TN3495782Medicaid