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1407817927

NPI Code Detail

MEDICARE: DR. NANCY P. MENDENHALL MD

MEDICARE: DR. NANCY P. MENDENHALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	ME39054	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	920006634	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407817927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY P. MENDENHALL MD

Provider Business Mailing Address
First Line	:	PO BOX 116304
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-6304
Country	:	US
Telephone Number	:	904-588-1263
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 JEFFERSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-3531
Country	:	US
Telephone Number	:	904-588-1263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	12/13/2011

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Directions to “ DR. NANCY P. MENDENHALL MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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