Provider Demographics
NPI:1861497356
Name:MENDOZA, JULIAN RM (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:RM
Last Name:MENDOZA
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 1:121 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4325
Mailing Address - Country:US
Mailing Address - Phone:765-642-8989
Mailing Address - Fax:765-649-1341
Practice Address - Street 1:121 W 23RD ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4325
Practice Address - Country:US
Practice Address - Phone:765-642-8989
Practice Address - Fax:765-649-1341
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033405208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C25300Medicare UPIN
IN141160Medicare PIN