Basic Information
| Provider Information | |||||||||
| NPI: | 1114911245 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELVIN M MENDEZ M.D., P.A. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 511896 | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339511896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412553722 | ||||||||
| FaxNumber: | 9412553723 | ||||||||
| Practice Location | |||||||||
| Address1: | 3410 TAMIAMI TRL | ||||||||
| Address2: | A1 | ||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339528127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412553722 | ||||||||
| FaxNumber: | 9412553723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2005 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| AuthorizedOfficialLastName: | MENDEZ | ||||||||
| AuthorizedOfficialFirstName: | ELVIN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9412553722 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., P.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | ME64431 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 47861 | 01 | FL | BCBS | OTHER |