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General NPI Number Information
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NPI Number | 1750582151
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Entity Type | Individual
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Provider Name | MILTON MENDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3950 TIGER BAY ROAD MEDICAL DEPARTMENT TOMOKA CORRECTIONAL INSTITUTION
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City | DAYTONA BEACH
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State | FL
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Zip | 32124-1042
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Country | US
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Telephone | 386-323-1141
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Fax | 386-323-1168
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Provider Business Mailing Address
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Address Line | PO BOX 3505 2337 LAKE TALMADGE DRIVE
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City | DELAND
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State | FL
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Zip | 32724
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Country | US
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Telephone | 386-734-6557
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Fax | 386-734-6572
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 9530
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN197
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License Number State | FL
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