Provider Demographics
NPI:1871653253
Name:MENDOZA, JOE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:
Last Name:MENDOZA
Suffix:JR
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:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380-1115
Mailing Address - Country:US
Mailing Address - Phone:940-888-5802
Mailing Address - Fax:940-888-5802
Practice Address - Street 1:5420 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1610
Practice Address - Country:US
Practice Address - Phone:940-692-5888
Practice Address - Fax:940-692-5888
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7535207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services