Provider Demographics
NPI:1457397671
Name:MENDEZ, MARIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1331 N STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2239
Mailing Address - Country:US
Mailing Address - Phone:417-881-8375
Mailing Address - Fax:417-889-5568
Practice Address - Street 1:1331 N STEWART AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2239
Practice Address - Country:US
Practice Address - Phone:417-881-8375
Practice Address - Fax:417-889-5568
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR76802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200049112Medicaid
MOD91156Medicare UPIN
MO200049112Medicaid