Provider Demographics
NPI:1942281290
Name:MENDEZ, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
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 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:561-805-8500
Mailing Address - Fax:561-805-8501
Practice Address - Street 1:349 NW 16TH ST
Practice Address - Street 2:STE 104
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-2839
Practice Address - Country:US
Practice Address - Phone:561-996-1990
Practice Address - Fax:561-996-9355
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F03566Medicare UPIN
124582Medicare ID - Type Unspecified