Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 2014-00246 | NC |
Y | 207N00000X | Dermatologist | OS7092 | FL |
N | 207Q00000X | Family Doctor | OS0007092 | FL |
NPI | 1033101175 |
---|---|
Provider Name | Jose E Mendez |
First Address | Miramar, FL 33027-2544 |
Second Address | Miramar, FL 33027-2544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251021901 | (05) | FL |
G22900 | (02) |