Provider Demographics
NPI:1740455831
Name:JOHN A. MENCHACA, M.D.,P.A.
Entity type:Organization
Organization Name:JOHN A. MENCHACA, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENCHACA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-336-7275
Mailing Address - Street 1:800 8TH AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2601
Mailing Address - Country:US
Mailing Address - Phone:817-336-7275
Mailing Address - Fax:817-336-8594
Practice Address - Street 1:800 8TH AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2601
Practice Address - Country:US
Practice Address - Phone:817-336-7275
Practice Address - Fax:817-336-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4226208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty