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General NPI Number Information
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NPI Number | 1225096787
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Entity Type | Individual
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Provider Name | WILLIAM MENDOZA MD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 05/07/2009
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Provider Practice Location Address
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Address Line | 1000 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6708
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Country | US
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Telephone | 850-863-7607
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Fax | 205-437-5998
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Provider Business Mailing Address
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Address Line | 2725 EDGEWATER DR
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City | NICEVILLE
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State | FL
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Zip | 32578-2310
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Country | US
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Telephone | 850-897-9106
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Fax | 850-650-8820
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME83187
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License Number State | FL
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