Healthcare Provider Details

I. General information

NPI: 1578819827
Provider Name (Legal Business Name): JOE SAMMY MENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CIRCLE OF HOPE DR
SALT LAKE CITY UT
84112-5550
US

IV. Provider business mailing address

2000 CIRCLE OF HOPE DR DEPT OF
SALT LAKE CITY UT
84112-5550
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-4024
  • Fax: 801-585-6613
Mailing address:
  • Phone: 801-587-4024
  • Fax: 801-585-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number10766526-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number283539-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number10766526-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: