MEDICARE: MICHELLE RENAE MENDEZ D.O.

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	207Q00000X	Family Medicine Physician	OS7488	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00369612	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1740202456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RENAE MENDEZ D.O.

Provider Business Mailing Address
First Line	:	PO BOX 440055
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-0001
Country	:	US
Telephone Number	:	904-282-6331
Fax Number	:	904-282-1550

Provider Business Practice Location Address
First Line	:	1909 BEACH BLVD
Second Line	:	SUITE 102
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-8608
Country	:	US
Telephone Number	:	904-246-2752
Fax Number	:	904-246-2758

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	06/09/2023

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