Healthcare Provider Details

I. General information

NPI: 1912034315
Provider Name (Legal Business Name): OMAR E MENDEZ-FIGUEROA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W 800 N
OREM UT
84057-3660
US

IV. Provider business mailing address

750 W 800 N
OREM UT
84057-3660
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-6387
  • Fax: 801-714-6596
Mailing address:
  • Phone: 801-714-6387
  • Fax: 801-714-6596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number173813
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD438151
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number7832454-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01095005
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier173813A1
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerPREFERRED CARE
# 3
Identifier173813
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerSHARED HEALTH
# 4
Identifier91102
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMVP
# 5
Identifier000462005001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerSENIOR BLUE
# 6
Identifier10016748
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerCDPHP
# 7
Identifier86E161
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBLUE CROSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: