Provider Demographics
NPI:1295765881
Name:MENDIUS, JOHN RICHARD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:MENDIUS
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 1:3883 AIRWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403
Mailing Address - Country:US
Mailing Address - Phone:707-521-7788
Mailing Address - Fax:707-521-7789
Practice Address - Street 1:3883 AIRWAY DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-521-7788
Practice Address - Fax:707-521-1309
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG403212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G403210Medicaid
CA00G403210Medicaid