Healthcare Provider Details

I. General information

NPI: 1609825132
Provider Name (Legal Business Name): PEDRO G MENDOZA M.D. FCCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CENTURY AVE
BISMARCK ND
58503-1401
US

IV. Provider business mailing address

300 W CENTURY AVE
BISMARCK ND
58503-1401
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-9900
  • Fax: 701-323-9911
Mailing address:
  • Phone: 701-323-9900
  • Fax: 701-323-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5553
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: