Provider Demographics
NPI:1013103209
Name:MENDEZ, ESPIRIDION REY (DO)
Entity Type:Individual
Prefix:DR
First Name:ESPIRIDION
Middle Name:REY
Last Name:MENDEZ
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 1:1309 LUVERNE DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8607
Mailing Address - Country:US
Mailing Address - Phone:814-323-5744
Mailing Address - Fax:814-295-5952
Practice Address - Street 1:217 W MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5648
Practice Address - Country:US
Practice Address - Phone:814-323-5744
Practice Address - Fax:814-295-5952
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8077207P00000X, 208D00000X
AZR2982390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6593OtherMEDICAL LICENSE
TXS8077OtherTEXAS MEDICAL LICENSE
TXS8077OtherTEXAS MEDICAL LICENSE
IL085003108OtherILLINOIS MEDICAL LICENSE
TXC0154436OtherCONTROLLED SUBSTANCE
TXS8077OtherTEXAS MEDICAL LICENSE