Provider Demographics
NPI:1912147521
Name:MENDEZ, EDUARDO S (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:S
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 1:9618 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6240
Mailing Address - Country:US
Mailing Address - Phone:954-517-1620
Mailing Address - Fax:954-517-1621
Practice Address - Street 1:9618 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6240
Practice Address - Country:US
Practice Address - Phone:954-517-1620
Practice Address - Fax:954-517-1621
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83615208D00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME83615OtherMEDICAL LICENSE
FLFR750ZOtherMEDICARE PTAN
FL009889100Medicaid
FLFR750ZOtherMEDICARE PTAN
FLFR750ZMedicare PIN