Doctor Name: | DR. MILTON MENDEZ |
NPI Number: | 1750582151 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 9530 |
Business Practice Address: | 3950 Tiger Bay Road Medical Department Tomoka Correctional Institution Daytona Beach, FL - 321241042 |
Business Phone Number: | 3863231141 |
Business Fax Number: | 3863231168 |
Mailing Address: | Po Box 3505, 2337 Lake Talmadge Drive DELAND |
State: | FL |
Postal Code: | 32724 |
Phone Number: | 3867346557 |
Fax Number: | 3867346572 |
NPI Enumeration Date: | 05/31/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 9530 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |