Provider Demographics
NPI:1780610568
Name:MENDEZ, PEDRO ERNESTO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ERNESTO
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 1:4700 N HABANA AVE
Mailing Address - Street 2:STE 702
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7160
Mailing Address - Country:US
Mailing Address - Phone:813-872-0613
Mailing Address - Fax:813-879-2644
Practice Address - Street 1:4700 N HABANA AVE
Practice Address - Street 2:STE 702
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7160
Practice Address - Country:US
Practice Address - Phone:813-872-0613
Practice Address - Fax:813-879-2644
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47218207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30682YMedicare ID - Type UnspecifiedPHYSICIAN
FLD54084Medicare UPIN