MEDICARE: DR. ERNEST J MENDOZA 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	207Q00000X	Family Medicine Physician	M0491	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00235710	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10034812	OTHER	TX	AMERIGROUP COMMUNITY CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8R9840	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1386625002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST J MENDOZA MD

Provider Business Mailing Address
First Line	:	21083 WILLIAMS CREEK DR
Second Line	:
City	:	PORTER
State	:	TX
Zip	:	77365-2380
Country	:	US
Telephone Number	:	713-299-5727
Fax Number	:

Provider Business Practice Location Address
First Line	:	22710 PROFESSIONAL DR
Second Line	:	SUITE 202
City	:	KINGWOOD
State	:	TX
Zip	:	77339-6008
Country	:	US
Telephone Number	:	281-312-8521
Fax Number	:	281-359-7971

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	03/16/2012

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Directions to “ DR. ERNEST J MENDOZA MD” Practice Location

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