Provider Demographics
NPI:1477528818
Name:MENENDEZ, ALEX (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MENENDEZ
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 1:100 W GORE ST
Mailing Address - Street 2:STE 201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1044
Mailing Address - Country:US
Mailing Address - Phone:407-245-3124
Mailing Address - Fax:407-245-3125
Practice Address - Street 1:100 W GORE ST
Practice Address - Street 2:STE 201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1044
Practice Address - Country:US
Practice Address - Phone:407-245-3124
Practice Address - Fax:407-245-3125
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0042963174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0623362OtherAETNA-HMO
FL0056137OtherGHI
FL209659OtherAVMED
FL2900083OtherUNITED HEALTHCARE
FL0056237OtherAETNA PPO
FL02985OtherBCBS
FL1827672OtherPHCS
FLK8639Medicare ID - Type Unspecified
FLD50700Medicare UPIN