Provider Demographics
NPI:1750582151
Name:MENDEZ, MILTON (MD)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MILTON
Other - Middle Name:
Other - Last Name:MENDEZ HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3505
Mailing Address - Street 2:2337 LAKE TALMADGE DRIVE
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724
Mailing Address - Country:US
Mailing Address - Phone:386-734-6557
Mailing Address - Fax:386-734-6572
Practice Address - Street 1:3950 TIGER BAY ROAD
Practice Address - Street 2:MEDICAL DEPARTMENT TOMOKA CORRECTIONAL INSTITUTION
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-1042
Practice Address - Country:US
Practice Address - Phone:386-323-1141
Practice Address - Fax:386-323-1168
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9530208D00000X
FLACN197208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice