Provider Demographics
NPI:1912034315
Name:MENDEZ-FIGUEROA, OMAR E (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:E
Last Name:MENDEZ-FIGUEROA
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 1:750 W 800 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3660
Mailing Address - Country:US
Mailing Address - Phone:801-714-6387
Mailing Address - Fax:801-714-6596
Practice Address - Street 1:750 W 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3660
Practice Address - Country:US
Practice Address - Phone:801-714-6387
Practice Address - Fax:801-714-6596
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173813207RC0200X
PAMD438151207RC0200X
UT7832454-1205207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01095005Medicaid
NY173813A1OtherPREFERRED CARE
NY173813OtherSHARED HEALTH
NY91102OtherMVP
NY000462005001OtherSENIOR BLUE
NY10016748OtherCDPHP
NY86E161OtherBLUE CROSS
NY86E161OtherBLUE CROSS
NY91102OtherMVP