Healthcare Provider Details

I. General information

NPI: 1659562395
Provider Name (Legal Business Name): JOSE LUIS MEJIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 ROUTE 217 SUITE 1
LATROBE PA
15650-3428
US

IV. Provider business mailing address

555 ROUTE 217 STE 1
LATROBE PA
15650-3438
US

V. Phone/Fax

Practice location:
  • Phone: 724-694-2723
  • Fax: 724-694-8830
Mailing address:
  • Phone: 724-694-2723
  • Fax: 724-694-8830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD445892
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: