MEDICARE: JOSE MENDEZ MD PA

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
2	207R00000X	Internal Medicine Physician
3	261QM0850X	Adult Mental Health Clinic/Center	ME107982	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14M9E	OTHER	FL	FLORIDA BLUE

General Provider Information

NPI Number	:	1407100951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE MENDEZ MD PA

Provider Business Mailing Address
First Line	:	8615 COMMODITY CIR STE 12
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-9072
Country	:	US
Telephone Number	:	407-476-1212
Fax Number	:	407-476-1213

Provider Business Practice Location Address
First Line	:	8615 COMMODITY CIR STE 12
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819
Country	:	US
Telephone Number	:	407-476-1212
Fax Number	:	407-476-1213

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE Y MENDEZ
Credential	:	MD
Telephone Number	:	407-738-3030

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	07/30/2020

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Directions to “JOSE MENDEZ MD PA ” Practice Location

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