Provider Demographics
NPI:1740257773
Name:MENDEZ, VICENTE ARTURO (MD)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:ARTURO
Last Name:MENDEZ
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 1:130 E REDSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5348
Mailing Address - Country:US
Mailing Address - Phone:850-398-7825
Mailing Address - Fax:850-398-8727
Practice Address - Street 1:130 E REDSTONE AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5348
Practice Address - Country:US
Practice Address - Phone:850-398-7825
Practice Address - Fax:850-398-8727
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011902310005Medicaid
E53939Medicare UPIN
476338Medicare ID - Type Unspecified