MEDICARE: DR. ALFREDO 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	207RT0003X	Transplant Hepatology Physician	ME92231	FL
2	207RG0100X	Gastroenterology Physician	ME0092231	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

General Provider Information

NPI Number	:	1649273871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFREDO MENDOZA MD

Provider Business Mailing Address
First Line	:	3001 EXECUTIVE DR STE 130
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33762-5323
Country	:	US
Telephone Number	:	727-347-0005
Fax Number	:	813-541-6558

Provider Business Practice Location Address
First Line	:	11912 SHELDON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3643
Country	:	US
Telephone Number	:	813-920-8882
Fax Number	:	813-920-8883

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/19/2021

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