Provider Demographics
NPI:1679573638
Name:MEJIA, JOSE G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:G
Last Name:MEJIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-8080
Mailing Address - Fax:321-434-8137
Practice Address - Street 1:6027 WALNUT GROVE RD STE 319
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2128
Practice Address - Country:US
Practice Address - Phone:901-226-3882
Practice Address - Fax:901-226-3883
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2018-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN58297208600000X
FLME81630208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261130900Medicaid
G88905Medicare UPIN
FL57954XMedicare PIN