MEDICARE: SERGIO A MENDOZA LATTES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	SP135	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41986	OTHER	IA	WELLMARK BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255324372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO A MENDOZA LATTES MD

Provider Business Mailing Address
First Line	:	PO BOX 63362
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28263-3362
Country	:	US
Telephone Number	:	800-782-6945
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 DUKE MEDICINE CIR
Second Line	:	CLINIC 1B/1C
City	:	DURHAM
State	:	NC
Zip	:	27710-4000
Country	:	US
Telephone Number	:	919-684-8111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	01/15/2015

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