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NPI Code Detail

MEDICARE: IVAN MENEZES MD

MEDICARE: IVAN MENEZES 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
1207PE0004XEmergency Medical Services (Emergency Medicine) PhysicianME78170FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
158836OTHERFLBC BS

General Provider Information

NPI Number : 1841273836
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVAN MENEZES MD
Provider Business Mailing Address
First Line : PO BOX 9430
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32120-9430
Country : US
Telephone Number : 386-274-7800
Fax Number : 386-274-7801
Provider Business Practice Location Address
First Line : 701 W PLYMOUTH AVE
Second Line :
City : DELAND
State : FL
Zip : 32720-3236
Country : US
Telephone Number : 386-943-4522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 03/24/2008

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Directions to “ IVAN MENEZES MD” Practice Location

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