Healthcare Provider Details

I. General information

NPI: 1811421357
Provider Name (Legal Business Name): ERICK VICTOR MEJIA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 MAIN ST STE 750
SARASOTA FL
34236-8000
US

IV. Provider business mailing address

8601 MILESTONE DR
SARASOTA FL
34238-3902
US

V. Phone/Fax

Practice location:
  • Phone: 512-586-6516
  • Fax:
Mailing address:
  • Phone: 512-586-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberOS16625
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS16625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: