Provider Demographics
NPI:1760430508
Name:MENDONSA, ROBERT EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
Last Name:MENDONSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-0977
Mailing Address - Country:US
Mailing Address - Phone:972-420-1776
Mailing Address - Fax:972-221-8685
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:#200
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3639
Practice Address - Country:US
Practice Address - Phone:972-420-1776
Practice Address - Fax:972-221-8685
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4348207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030782901Medicaid
TX200031204OtherRAILROAD MEDICARE
TX8BF128OtherBLUECROSS
TX030782901Medicaid
TX1193630001Medicare NSC