Provider Demographics
NPI:1649475278
Name:ALLISON V MENEZES MD PLLC
Entity type:Organization
Organization Name:ALLISON V MENEZES MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:MENEZES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-921-6161
Mailing Address - Street 1:4855 FEATHERBED LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-1558
Mailing Address - Country:US
Mailing Address - Phone:941-921-6161
Mailing Address - Fax:866-456-4659
Practice Address - Street 1:6040 53RD AVE E UNIT A
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9720
Practice Address - Country:US
Practice Address - Phone:941-921-6161
Practice Address - Fax:866-456-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65322207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF8545OtherRAILROAD MEDICARE
FLAD135OtherMEDICARE GROUP NUMBER
FLG17385Medicare UPIN
FLAD135OtherMEDICARE GROUP NUMBER