Provider Demographics
NPI:1760445936
Name:MENDEZ, LEOVARES A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEOVARES
Middle Name:A
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 1:710 E CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-4640
Mailing Address - Country:US
Mailing Address - Phone:972-905-3520
Mailing Address - Fax:972-278-3485
Practice Address - Street 1:710 E CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-4640
Practice Address - Country:US
Practice Address - Phone:972-905-3520
Practice Address - Fax:972-278-3485
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6450Medicare ID - Type Unspecified