Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME64431 | FL |
NPI | 1003800939 |
---|---|
Provider Name | Dr. Elvin M Mendez |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Port Charlotte, FL 33980-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014287900 | (05) | FL |
47861 | BCBS (01) | FL |
47861Y | (02) | FL |
F90243 | (02) | FL |