Healthcare Provider Details

I. General information

NPI: 1407941784
Provider Name (Legal Business Name): ROBERT R MENDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL SUITE # 108
RALEIGH NC
27607-7513
US

IV. Provider business mailing address

4414 LAKE BOONE TRL SUITE # 108
RALEIGH NC
27607-7513
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-2300
  • Fax: 919-784-2301
Mailing address:
  • Phone: 919-784-2300
  • Fax: 919-784-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number200100421
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number200100421
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: