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General NPI Number Information
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NPI Number | 1891796058
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Entity Type | Individual
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Provider Name | JOSE KIAMCO MENDOZA JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 4502 HIGHWAY 951
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City | JACKSON
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State | LA
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Zip | 70748-5103
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Country | US
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Telephone | 225-634-4820
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Fax | 225-634-0489
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Provider Business Mailing Address
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Address Line | 4502 HIGHWAY 951
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City | JACKSON
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State | LA
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Zip | 70748-5103
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Country | US
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Telephone | 225-634-4820
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Fax | 225-634-0489
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 023159
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 023159
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License Number State | LA
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