Provider Demographics
NPI:1952532566
Name:RODRIGUEZ MENDEZ, WILSANIA L (MD)
Entity Type:Individual
Prefix:
First Name:WILSANIA
Middle Name:L
Last Name:RODRIGUEZ MENDEZ
Suffix:
Gender:F
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:POST OFFICE BOX 769
Mailing Address - Street 2:
Mailing Address - City:BAYOU LA BATRE
Mailing Address - State:AL
Mailing Address - Zip Code:36509-0769
Mailing Address - Country:US
Mailing Address - Phone:251-824-2174
Mailing Address - Fax:251-824-2286
Practice Address - Street 1:12701 PADGETT SWITCH ROAD
Practice Address - Street 2:MEDICINE DEPT.
Practice Address - City:IRVINGTON
Practice Address - State:AL
Practice Address - Zip Code:36544-4011
Practice Address - Country:US
Practice Address - Phone:251-824-2174
Practice Address - Fax:251-824-2174
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL140600Medicaid
AL511-28738OtherBLUE CROSS BLUE SHIELD
AL102I119046Medicare PIN