Healthcare Provider Details

I. General information

NPI: 1114911245
Provider Name (Legal Business Name): ELVIN M MENDEZ M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 TAMIAMI TRL A1
PORT CHARLOTTE FL
33952-8127
US

IV. Provider business mailing address

PO BOX 511896
PUNTA GORDA FL
33951-1896
US

V. Phone/Fax

Practice location:
  • Phone: 941-255-3722
  • Fax: 941-255-3723
Mailing address:
  • Phone: 941-255-3722
  • Fax: 941-255-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME64431
License Number StateFL

VIII. Authorized Official

Name: DR. ELVIN M MENDEZ
Title or Position: OWNER
Credential: M.D., P.A.
Phone: 941-255-3722