Provider Demographics
NPI:1851918221
Name:MENENDEZ, JOSE (DO)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MENENDEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14884 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MS
Mailing Address - Zip Code:39327-9697
Mailing Address - Country:US
Mailing Address - Phone:601-635-2258
Mailing Address - Fax:601-635-2259
Practice Address - Street 1:14884 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MS
Practice Address - Zip Code:39327-9697
Practice Address - Country:US
Practice Address - Phone:601-635-2258
Practice Address - Fax:601-635-2259
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS31814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine